21 December 2012

UK and Australian Attitudes to Aid: A tale of two countries

"It's a Policy Knockout" shouts a Prospect magazine article by Peter Kellner, president of YouGov, the polling firm, in the January 2013 edition.

YouGov conducted a poll for Prospect on the policy choices the UK public most want.

Instead of ranking the 16 options as a list, the 16 were set up in a Champions League style knockout tournament.

"Cut overseas aid" was one of the 16 options put forward by YouGov. In the round of sixteen, Cut ODA was more popular than "tax £2m properties". In the quarterfinals it was more popular than "end all immigration" (quite an feat--see the AusAID story below).  In the semis it was more popular than "improve the NHS" (our national health service, which could do with some improving). So "cut overseas aid" made it to the final, but was beaten by "crack down on firms that avoid tax" which was the most popular of all policy choices (at least ODA is more popular than Google and Amazon--hang on, that's not saying much).

As the article notes, the options that were more popular not only reflected their innate desirability to those polled but also the perceptions of the feasibility of politiicans actually doing something about them.

And while--apologies to Chelsea fans--cup competitions like the Champions League have a lot of luck attached to them, the results above deserve serious attention.

In the same edition of the Prospect there are two letters relating to articles in previous editions. One letter is from former DFID Secretary of State Clare Short, defending the MDGs against an "attack" from Clare Lockhart. Another letter is from Andrew Christensen agreeing with an article by Ian Birrell on "aid being a poor answer to poverty". As we are on the verge of a step increase in the UK aid budget (at least in terms of the percent of GNI) this is perhaps not surprising. As usual, the evidence base is absent from most of these arguments (although not in Clare Short's letter).

I would really like to see a big picture view of what all the systemic reviews from the past 3 years have done to support or undermine the "aid effectiveness" picture. Can someone work with DFID, 3ie and AusAID to tell us?

And even if the evidence was clear and rigorous, it would still be contested--we need to rethink how we communicate when aid is and is not effective.

Talking of AusAID, Australians are also angry about ODA. But not because it is too high, rather because it has been "cut".

I put cut in quotes because technically the aid budget is intact (although an increase for next FY was postponed back in May) but rather because a chunk of it has been reallocated. Specifically 375m Australian dollars (out of about 5 billion) of ODA has just been allocated to meet the needs of refugees to Australia, in Australia. The opposition are somewhat gleefully describing Australia as the third largest recipient of AusAID, behind Indonesia and PNG. Backbenchers on the centre left are not happy either.

The Government is claiming that this use of ODA is in line with OECD DAC definitions. And indeed it is, the DAC stating

"Assistance to refugees in developing countries is reportable as ODA. Temporary assistance to refugees from developing countries arriving in donor countries is reportable as ODA during the first 12 months of stay, and all costs associated with eventual repatriation to the developing country of origin are also reportable."

The Australian NGO community is not happy (see a joint editorial from World Vision Australia and Caritas Australia) and the centre right opposition is making the most of it (the Government can't keep its word and made cynical promises on aid to secure the Security Council seat etc.). And while Australian aid has been growing rapidly, as a percent of GNI is it still in the bottom half of the DAC league table. 

My only comment on this is the irony of it all. While aid is so political in the countries of origin, we treat it as apolitical in the countries of destination. 

Apparently something magically happens to it during the transfer.   

19 December 2012

What do we want? Nutrition sensitive agriculture! How do we incentivise it? No clue

The past month has seen three important publications on nutrition-sensitive agriculture.

First, a paper from Anna Herforth, Andrew Jones and Per Pinstrup Andersen, commissioned by the World Bank. This paper develops 8 "Guiding Principles for Operational Investments" (pdf) for prioritising nutrition in agriculture and rural development. There are many sensible things in here (not surprising given the calibre of the authors) and it is a good menu of what to do if you want to improve the nutritional impact of your agricultural interventions: include a nutrition objective, target nutritionally vulnerable groups, invest in women, improve food safety and the nutritional quality of food, minimize water borne disease hazards, improve nutrition education, policies, taxes and subsidies to incentivise certain strategies, increase capacity to identify and seize multisectoral opportunities for nutrition and better impact evaluation.

Second, a paper by Noreen Mucha for the Bread for the World Institute (pdf). This paper is on nutrition sensitive development more generally. It talks about the importance of identifying pathways to nutritional impact, and the importance of setting objectives, and then monitoring them over time. The paper has a useful collection of definitions of nutrition sensitive development and calls for global normative body or bodies to define nutrition sensitive development to avoid the old wine in new bottles syndrome.

The third paper is by Robert Paarlberg, and is an evaluation of the IFPRI 2020 Conference in 2011 on Leveraging Agriculture for Improving Nutrition and Health in Delhi (pdf). The report tries to assess the impact of the conference on individuals, institutions and discourse using participant surveys, personal interviews and web searches. For individuals the conference had a small impact on their views--it had a bigger impact on motivation and empowerment, at least in the short term. At the institutional level the findings were that NGOs and the private sector were not much affected, because they are already comfortable working across sectors. The institutions that found it most useful were the agricultural ones, looking for entry points. The discourse was measured by links on websites to nutrition-agriculture issues and these were much higher immediately after the conference and even over one year later (of course there could be other factors at play). 

These 3 papers are all valuable. But none of them focus on the incentives for agricultural and nutrition professionals or organisations to engage with each other. For the IFPRI conference 75 % of conferees surveyed were already convinced of the need for a cross-sectional approach--what about the other 25% and, more importantly perhaps, the ones who did not attend? The Herforth et. al. paper assumes there is a willingness of some agricultural professionals to focus on nutrition, but says very little about what to do to incentivise more of them to want to engage with nutrition. The Mucha paper says that "experts agree that reducing maternal and child undernutrition will require nutrition sensitive actions", but what will drive the actions? The Paarlberg paper notes that the IFPRI conference had the least traction within governments where undernutrition is high. This reflects their reality: few degrees of freedom and weak incentives. 

It is important to know what to tell policymakers when they ask "what can I do?" But I would argue it is more important to (1) know how to get more of them asking the question in the first place and then (2) understand the incentives and barriers to getting any subsequent policies implemented across sectors. 

So what are the incentives? At a policy level taxes and subsidies might have a role to play. Donors can always incentivise short term collaboration. And in the longer term surely multisectoral training in nutrition and agriculture --whether accredited or not-- is key. 

But the best way to find out about the incentives and barriers is to do some market analysis: ask the agriculturalists and nutritionists to identify the barriers and what they think would help overcome them. That is a study I would like to see. 

18 December 2012

Evidence: Is the pendulum swinging back to the centre?

The past 4-5 years have seen a flurry of Randomised Controlled Trials (RCTs) and Systematic Reviews come into the international development space.

In general, I think this has been a good thing. It certainly was odd that there were so few of each prior to 2008. 

However, pursued in an unthinking way, we know these methods can be unhelpful. 

RCTs which spend a lot of money to figure out if something works in one place at one time do not tell us much about why they work and whether they will work elsewhere. 

And Systematic Reviews tend to look at only one outcome of an intervention, even if multiple outcomes have been explored by those studies.

A mechanistic application of these processes can lead to a kind of multicollinearity in the evidence.  Multicollinearity is an econometric term for lines fit to data when all the data are highly correlated. This makes the estimates very unstable (think of a table top being balanced on 4 legs which are all situated in a line, i.e. correlated). 

Is the pendulum swinging back to the centre? Based on very unsystematic and uncontrolled evidence, my intuition tells me "yes".

In the past few months 2 examples have come my way.

The first is a paper by Chris Bonell et. al. 2012 in Social Science and Medicine which argues for Realist RCTs: that is, RCTs which have many arms, which focus on mid level programme variables, operate in several sites, and draw on complementary qualitative analysis. The authors argue that the extra costs involved in multiple answer are more than recovered by the resources not spent on single answer RCTs. I agree with all this, but having been involved in many funder-researcher negotiations, the outcome frequently seen is a stripped down RCT and so I am under no illusions about how difficult this is to do. 

The second is a paper lead authored by my IDS colleague Michael Loevinsohn and others, which is a "re-review" of a systematic review by Waddington and Snilstveit  on the effectiveness of water, sanitation and hygiene interventions on diarrhoea prevention. They review a subset of the papers in the original review which described local context and which interventions allowed for greater agency of individuals in how they use or apply the interventions. While finding no fault with the original study, the authors find that the protocol used led to many impact pathways and additional insights being missed. They argue that this is because systematic review protocols tend to narrow down the terrain along disciplinary, outcome and intervention lines, presumably sometimes to make the study manageable, but perhaps often just out of habit. If you want to request a copy, I suggest you contact m.loevinsohn@ids.ac.uk
I found these two papers to be interesting twists on two approaches that have become quickly entrenched in development evidence generation. 

I like the two papers because they do not throw the baby out with the bathwater--they recognise the usefulness of the two approaches--and they try (successfully in my view) to adapt them for the complex world we live in.

15 December 2012

Foreign Policy Top Global Thinkers: Relevance for Development?

Every year Foreign Policy (FP) produces its list of top 100 global thinkers. OK, so FP says that "policy making is more or less the opposite of thinking" nevertheless many of the thinkers caught my attention. They fall into two categories: the insiders and the refreshers. 

The insiders are already part of the development firmament and are making huge contributions: Esther Duflo (poverty experiments and impacts), Bill and Melinda Gates, Joyce Banda (new Malawian President, taking on vested interests to reduce poverty), Ngozi Okonjo Iweala (Nigerian Finance Minister, taking on vested interests to help more oil income go to poverty reduction), Bjorn Lomborg (Copenhagen Consensus etc,), Sri Mulyanai Indrawati (former Indonesian Finance Minister, now Managing Director at the World Bank, for fighting Indonesian corruption), Nitish Kumar, Chief Minister of Bihar, for "turning around India's poorest state" and Daron Acemoglu and James Robinson on Why Nations Fail (extractive institutions which are used by those in power to create poverty for many and wealth for themselves).

But it is the refreshers who I found most interesting. The refreshers are those who would not frame themselves within the development community, but whose work may have nonobvious but potentially huge and relevance for development. They include:

  • Shai Reshef, Founder of University of the People in the US (tuition-free, first rate university education to anyone who speaks English and has an internet connection) and Daphne Koller and Andrew Ng founders of Coursera (1 million students online from 196 countries, linked to 30 universities). Will quality tertiary education access become a reality for hundreds of millions in this way?
  • Michael Sandel on the moral limits of markets. The more we commodify everything and put a price on anything, the more we generate inequality (the rich can now buy them) and the more we devalue the social value of what we commodify. We are surely going through a period when we are thinking hard about what markets can and cannot do and what they should and should not do. Sandel's thinking should will help.
  • Kiyoshi Kurokawa, author of a report commissioned by the Japanese government on the meltdown at Fukushima. The report boldly criticised groupthink and collusion. The report says that Japanese culture is particularly vulnerable to this, but I have seen plenty of it in international development (e.g. the risks of resilience bandwaggoning). Orthodoxy creeps up on us and we must always be open to having it challenged.
  • Ruchir Sharma on Breakout Nations. The emerging markets of the last decade will not be most likely to drive growth in the next one--we need to look to the next breakouts: Philippines, Indonesia, Turkey, Poland, Thailand, Sri Lanka and Nigeria. Do the BRICS already need re-pointing?
  • Ricken Patel, co founder of Avaaz, a transnational activism movement with over 16 million members, supporting gay rights, evacuate journalists, break prostitution rings in international hotel chains, and coordinating assistance in a guerilla war. Why isn't there something like this for hunger reduction?
  • John Coates, exposing how biology affects Wall Street--as profits mount, so does testosterone and irrational exuberance (and you know the rest). Solution? Hire more women and older men on the trading floor and delink massive bonuses from short term profits. Does something similar happen in development agencies on spending targets and promotions?

The insiders are good value, but perhaps the refreshers can be even more transformational.

12 December 2012

The MDGs: Where Does Nutrition Fit?

At a recent nutrition meeting I realised that I don’t yet have a clear idea of where nutrition should fit into the next set of development goals.

I also realised that the wider nutrition community has not had this discussion either.

As many critical decisions will be made in the next 6 months, we need to get our act together.

So what are the options?

A preliminary set might look something like this:

1. Business as usual.

That is, the underweight indicator in the poverty and hunger MDG. This seems unsatisfactory given the ambiguity attached to underweight—improvements in it do not necessarily track healthy growth (e.g. overweight but short kids).

2. Nutrition as a separate MDG.

There is probably not enough political space for this, given that the MDG set is already health-heavy. But if there were space would this be a good thing? It would probably draw more resources to nutrition (that is what the health MDGs did, by most accounts) and heaven knows nutrition needs that. It would also be a goal that could be embraced by rich and poor countries alike, thus unifying the under and over nutrition sides of the coin and generating a truly global goal, leading the way on other goals that will have to be global. A battery of indicators would be used: stunting, wasting and a healthy range for underweight (young children) and body mass index (adolescents and adults). The World Health Assembly might be supportive of this given the stunting target they recently announced.

3. More nutrition indicators throughout the MDGs, but no MDG on nutrition.

This seems more politically feasible, but maybe less desirable for the reasons given above. If it were an option, what would go where? Stunting is a marker of chronic undernutrition, but it is also a marker for poverty and deprivation in general. It could be used as an indicator for MDG1, with the hope that its existence will bring nutrition interventions into the poverty frame as they are a proven way of moving a stunting MDG1 indicator in sustainable ways that which generate high benefit cost ratios. Did this happen with the underweight indicator? I don’t think so, but I could be wrong. But even if I am right, things might be different now with the energy of the SUN movement. Wasting could be used as an indicator of child ill-health—we know that kids with severe acute wasting are many times more likely to die as kids without. Ironically this could help the treatment of SAM be better rooted in the health sector (it does not have much traction there). Diet diversity could be an indicator of food security (quantity, indirectly and quality, directly) and of agricultural productivity (via income effects and via improved physical access to food where markets don’t work well). If we could measure resource use and ecosystem services, we could begin to think about sustainable diets.

There could be combinations of 1 and 3 and 2 and 3.

There are probably other options out there.

And then there is the case of targets and timelines: should the aspiration be to end undernutrition? To halt the increase in overnutrition? To halve both rates?

What do you think?