Tag: USAID

BOOK REVIEW: The Enduring Struggle: The History of the U.S. Agency for International Development and America’s Uneasy Transformation of the World

BOOK REVIEW:  The Enduring Struggle:  The History of the U.S. Agency for International Development and America’s Uneasy Transformation of the World, by John Norris.   2021.   Lanham MD:  Rowman & Littlefield Publisher.

America’s primary international assistance organization, for moving federal tax dollars to solve global problems, has for over 60 years been the United States Agency for International Development, known more commonly as USAID (or in the past, AID).

USAID has had a long and illustrious history of providing varied development and emergency assistance in most countries of Africa, Asia, Latin America, the Middle East and the former Soviet Union since its founding in 1962 at the initiative of President John F Kennedy.  In The Enduring Struggle, author John Norris tackles the sweep of USAID’s work, starting in the late 1950s.  The book is organized largely around big new decadal initiatives undertaken.    Parenthetically, it recounts the creation of the separate Millennium Challenge Corporation.

This book provides readers with the context for how anti-hunger programs are marshalled for federal funding of agriculture, “feed the future,” nutrition, livelihoods, and anti-poverty projects by NGOs in Africa, Asia and Latin America.

The USAID Alumni Association provided critical support for the writing.  One supporter, Alex Shakow, says “We are especially pleased. We hope that students and scholars will, over time, dig more deeply into the many issues raised and programs… readers have said all AID staffers should read the book to help them better understand the history, experience, and culture of the agency of which they are a part.  In fact, AID Management has made it possible for every person in AID to have access to the book.”

Norris, who has written other books (including Disaster Gypsies) and a blog about political leadership at USAID, orients his history from the view of senior political leaders in Washington, DC.  Norris gives human face by quoting political appointees who interfaced between USAID, the White House and Congress.  More attention is given to USAID’s top officials (the head being called “Administrator”) and White House strategists, than to career aid specialists working in the field.  There is scant specific description of USAID’s large field offices, which today are in over sixty countries,, though Norris drew heavily on the many “oral histories” that have been done by many alumni and available at:  https://adst.org/oral-history/oral-history-interviews/#gsc.tab=0

The author credits a sea change in the US approach to foreign aid to Herbert Hoover who engineered life-saving food aid to Europe during World War I to Belgium and then after that war to the Soviet Union.  He gives weight to different decades, including the 1960’s and 70’s when there was an emphasis on endless new policy making, planning exercises and constant addition of new requirements for funding.   Aid had to reposition itself time and again, such as when it was no longer needed strategically as a tactic in the Cold War.  He notes the biggest jumps in USAID’s budget occurred under Republican Administrations (e.g. Bush, Reagan).  It casts light on provision of aid inside war zones, including Vietnam, Central America and Afghanistan.

The Enduring Struggle addresses food security and food aid, and health (smallpox, HIV, COVID-19), but keeps a broad sweep of initiatives, without discussion of the NGOs, Universities, UN agencies, and local organizations designing and implementing aid projects.  Norris covers the important early initiative to promote family planning was controversially led by Rei Ravenholt who had “unusual latitude and authority over personnel, spending and the direction of the program, reflecting a focus in the 1960s and 1970s on over-population.  This program laid the groundwork for dramatic decreases in fertility and a long-term plateau in population growth.

Norris’ references to food assistance, which has been the most popular, robust and consistent part of foreign aid (of over $100 billion in aid) are derived from selective and few references that led to further misconceptions about the effectiveness of Title II food aid, mostly delivered by NGOs and the World Food Programme.  He conveys none of the achievements in promoting local food security that have accounted for $100 billion of nonprofit efforts across the world during the last half-century.  Norris diminishes food aid as the product of farm and shipping lobbies, ignoring how US nonprofits fighting hunger have been the biggest supporters of food aid to Congress.

USAID Alumni leader, Alexander Shakow, who helped arrange for Norris to have inputs from USAID alumni, said “We are especially pleased that AID staff, current and retired, have been very positive in their reactions.  …Norris has made excellent use of AID retirees’ oral histories, files from Presidential libraries, and many other sources that bring his stories of major programs to life, and as a result the book is a very interesting read in addition to all the substance that one learns.”

The author gives greater attention in many cases to the politics or news-version of issues than the relevance in the field.  He comments about how HIV/AIDS was identified in the early 1980s but not a topic of interest to the President of the United States, presumably as a theme for foreign aid.  This makes little sense because, apart from Haiti, the AIDS epidemic was not understood at that time to be a problem elsewhere in the world.  It was really only in the 1990s (long after Reagan) that USAID programs revealed the prevalence of AIDS infection in countries like Malawi and much of southern Africa.

A strength of this book is that it is well vetted and is accurate in what it does  cover, particularly the politics of aid.  What’s unfortunate is that it does not touch on what was actually accomplished (for instance, lives saved) with US taxpayer’s taxes, in the form of a great many momentous successes of USAID (it does mention the eradication of smallpox).  It conveys well the inside baseball politics of USAID meetings in the Cabinet and White House.  But, in the end, it gives little insight about what assistance looks like at the level of its delivery in the field.

In the final chapter, Norris writes “The United States Agency for International Development has been in existence for sixty years, and foreign assistance has been established as an important part of the American ethos…. Aid can provide incentives for reform and encouragement and support to local reformers.  But it cannot, by itself, overcome entrenched resistance by those who benefit from bad policies or corrupt politics.”

He concludes, “As this history describes, the United States and other donors have delivered lifesaving humanitarian assistance to millions upon millions of people since 1960; without that assistance the death toll from wars and famines… would have been far higher.”

Shakow adds that “We hope that students and scholars will, over time, dig more deeply into some of the many issues raised and programs left without adequate detail.  Many readers have said all AID staffers should read the book to help them better understand the history, experience, and culture of the agency of which they are now a part.  In fact, AID Management has made it possible for every person in AID to have access to the book.”

One interview with the author, as streaming media, at the think tank CSIS, can be found at:  https://www.csis.org/events/book-event-enduring-struggle-conversation-john-norris

The Razor’s Edge: Embezzlement, Corruption and Development in Ethiopia, a Novel (2022)

For anyone interested in learning what development work overseas entails and what work is like, there may be no better introduction than Robert Gurevich’s novel, The Razor’s Edge.  Thinly modeled on his own experiences in Africa, with his protagonist, writing in the first person, caught between the US Government’s Agency for International Development (USAID) and non-governmental organization work, primarily in basic education for kids.  The book follows the adventures of a westerner hired to lead an NGO’s (KAP) education program of schools, collaborating with parent-teacher associations, and building on models that have worked.

One reviewer on Amazon agrees:  “Any development worker contemplating taking a senior foreign posting, especially with an NGO, on a government-funded education project could benefit from reading this book.” The 2002 story is an easy read at 298 pages, with the subtitle “Embezzlement, Corruption and Development in Ethiopia, a Novel”. 

He starts the book as the new project director of a USAID-overseen project supporting 2,500 primary schools in Ethiopia.  The journey of the protagonist has formed experiences at each stage of his project work, from being proposed to USAID through to meeting staff, implementation, accounting, responding to evaluations of his program, and controversies that have arisen over the years which include observing staff turnover and allegations of fraud.  The author repeatedly debates how to interact with USAID – the main funder — regarding his choices, presentations, and reporting USAID is likely to accept or reject.  Though budgets are not discussed, key realities of development programs are milestones, timelines, and scaling.

Hunger and malnutrition enter the plot when there is a poor harvest, to which the NGO and their donors respond with school feeding. School feeding has been a large part of aid programming for decades, particularly as an incentive for girls to attend school.  Late in the book, Ethiopia suffers a drought, for which USAID provides new resources to KAP (“a large emergency grant”) to support school feeding programs to encourage children to continue attending school, help them have the strength to travel to school and nutrition to help pay attention and learn in the classroom. The protagonist observes USAID efficiently sought to “utilize an already existing project for addressing this emergency quickly.

In the telling, hot, cooked meals (i.e., “wet food”) were provided. “With wet food, we know for sure that the food is consumed by the child and not taken by an older family member at home.  By eating the meal at school , this makes all the children continue to attend.”

Other insights about the challenges of aid work appear in each chapter, such as “the major problem has been the use of cash payments to schools, along with lax scrutiny.  I am recommending each beneficiary school be required to open an account with the nearest bank, credit union… into which project funds can be deposited.”

Two choices families face are:  “For children to continue their schooling beyond the four grades offered in the village school, they would need to move to a town with a primary school offering eight grades, and, later, a secondary school.  These children would need to live with someone.” or “Parents need the labor of children during certain times of year, keeping them out of school at these times. But when the children fall behind their classmates, they become embarrassed and drop out.”

The author is an anthropologist, specializing in education, working in consultancies for USAID and the Peace Corps, Chairman and Member of the Board of Directors for the USAID-funded Sustainable Agriculture and Natural Resource Management Collaborative Research Support Program. Among other technical achievements, in 2015 he evaluated the USG’s education portfolio in Yemen.

In his way, Gurevich pays homage to the 1944 novel of the same name by Somerset Maugham where the protagonist, also, travels far and wide seeking to discover transcendent liberation from human suffering.  It took its title from the ancient Upanishads verse “The sharp edge of a razor is difficult to pass over; thus, the wise say the path to Salvation is hard.”

https://www.amazon.com/Razors-Edge-Embezzlement-Corruption-Development/dp/1950444295

Pandemics and Hunger:  Part 2 of Our Interview with Dr. Ron Waldman

Exclusive content from the World Hunger Education Service.  June 2020.  Dr. Ron Waldman reflects on lessons of pandemic preparedness and response, the roles of the USG and UN and recommended references.

Hunger Notes editors Peter Morris and Steve Hansch interviewed pandemic expert Dr. Ron Waldman (RW), Professor of Global Health at George Washington University’s Milken Institute School of Public Health, Board President of Doctors of the World, author,  and long-time point person for international health in emergencies for USAID and the Centers for Disease Control and Prevention (CDC).  This article continues the interview begun at:  www.worldhunger.org/pandemics-crisis-and-hunger-an-interview-an-interview-with-dr-ron-waldman1

What, if anything, most surprises you about how this COVID-19 outbreak has played out? 

RW:   What surprises me is that people seemed to have under-estimated the importance of political leadership when a serious problem affects societal functions as a whole.  Frankly, it surprises me the degree to which this turns out to be important.  When you look at Germany or New Zealand, you see that it was really the ability of those governments to make decisive, intrusive decisions like restricting movement, and to do so with a battery of public health measures instituted simultaneously, that led to reasonably good results.  In those countries where leaders were reluctant to make those decisions at all, or where they made them incrementally, like “Oh-I-don’t-really-want-to-do-this” next step implementation; those countries are getting hit hard.  Those countries that are more decisive have done much better.

Australia made this sort of firm decision ahead of the curve.  Austria is another example of that.  It’s not liberal or conservative, it’s decisive.

It is really interesting how wrong “the experts” were.  For instance, some of the more prominent ranking of countries in regard to their preparedness for an event like this had the US, UK, and France way up at the top of the charts.  That’s because they left out some of the important criteria that comprise preparedness and tended to focus on health-specific, technological factors.

Have any recent public communications concerned you?

RW:   I think there are things that seem to be logical things to do that don’t necessarily have the best science or evidence behind them.  Such as all the calls now for wearing masks in public places.  At the start of the outbreak scientists were saying that it is silly to wear masks or that it’s really the people who are sick who need to wear masks.  But now it has sort of become a given that if you’re outside in a crowded place, you should wear a mask.   It’s come about because it seems to be a logical thing to do.  And now the scientists are saying that the science supports it, although exactly the opposite was true at the onset.  It’s really a bit Brave New World-ian, isn’t it? That’s one mess-up of communications.

All of these times that the scientific experts reverse themselves, it makes science look bad.

And now, the science doesn’t really seem to matter because everything, including masks, has become political symbols.  Republicans aren’t wearing masks, so Democrats condemn them.  What does viral transmission dynamics have to do with political affiliation?  Only in America (and maybe a few other countries).

President Trump has been saying there are States that are just locking down too much.  I don’t know what the evidence basis is for making this conclusion.

There still is a lot of confusion, obviously about testing.  I was upset when they were first talking about “testing, testing, testing”.  The goal is not merely to test.  It’s not like the country that does the most testing wins.  It’s just a shorthand for identifying cases as early as possible by diagnostic means.  They could have said people who meet this case definition should be presumed positive.

The series of events cannot stop with testing – it needs to continue with contact tracing, any of the contacts exhibiting symptoms need to be isolated.  And the others should be quarantined for one incubation period.  That has not been communicated to the public well. Testing, contact tracing, isolation, quarantine.  Now people are starting to understand that, but the WHO Director-General went on about “testing, testing, testing”, as shorthand, and a lot of people picked up on that.  They didn’t understand the broader implications so they didn’t prepare for them

I don’t think people understood there are two completely different kinds of tests:   Diagnostic and antibody tests tell you different things and are useful for different decisions.  This is another bad element of risk communication.

What about Communications related to a vaccine and about herd immunity?

RW:   There seems to be a feeling out there that there is going to be a vaccine in 18 months.   Because scientists said it would take at least 18 months. There’s no vaccine for SARS or MERS (another coronavirus disease).  That’s been one of the holy grails. There’s no guarantee there’s going to be a vaccine, ever!  If it doesn’t happen, there’s going to be a lot of disappointment and rebellion against the scientific community.  The scientific community does not understand how the public takes the pronouncements from scientists.  There are encouraging signs but vaccine development is one thing.  Mass production and equitable distribution are different ball games. Certainly we all hope it can happen.  But we should have modest expectations and not put all our eggs in the vaccine basket (perhaps not as apt a metaphor as in the past).

Another area that is murky is whether or not immunity develops.  Everyone and their brother now can opine.  All the TV doctors are now experts, using words like antibody testing, reproductive number and herd immunity, which many of them don’t understand well. The economists also.  People say that whenever you see an economist on television, they tell you all about the transmission dynamics and the development of immunity.  But whenever you see an epidemiologist, they say “I don’t know”.  That’s what I say in all of my interviews and it should be made clear here:  the starting point is “I don’t know”.  How could anyone know?  The whole point is that this is a new virus that we have never seen before.  It has been in humans for about 5 months. How much can we be expected to know?  Of course we can make inferences from past experiences with similar viruses and other pandemics, but we need to do so modestly and with the expectation of being proved wrong.

There’s this idea now that the so-called strategy of herd immunity is to open early and let the virus run its course, so then everyone will be infected and become immune.  That’s not actually the way it works.

Sweden is more or less pursuing this strategy now, in fact, if not in theory.  Although the Sweden case is complicated and there are other, political and regulatory, reasons why they are only suggesting public health measures to their population, not prescribing them.  Unlike people in many countries, such as the one in which this interview is being conducted, Swedes tend to behave like responsible adults.  But what they are doing is somewhat dangerous.  Some of the smaller studies in Washington State, and other places, and even in Stockholm have found that antibody prevalence in the community is much lower than what was initially predicted.  The virus seems to spread very heterogeneously.  Chris Murray’s data [at the University of Washington University] suggests that by the time this initial wave of transmission has run its course, maybe sometime in mid-August, there will be only about 4-5% antibodies prevalence in the population.  Meaning 96% of the population will remain susceptible to another outbreak next winter.

Can you comment about the kinds of planning and preparedness that you worked on for many years for exactly this type of outbreak?  

RW:   Most of the planning that I was involved in was done in conjunction with a dedicated UN agency, or unit, called the UN Secretariat for Influenza Coordination (UNSIC).  It was chaired by Dr. David Nabarro, had a staff of about 10-15, and received $125 million from USAID and had a number of other donors. As a whole, the pandemic preparedness business began in the 2000s, when the world was facing the threat of the avian influenza virus, also known as “H5N1,” a virus that appeared in 1997.  It was very threatening because almost every human who contracted the virus would die, an 80% case-fatality ratio.  Though, it was not very transmissible, and mostly moved within families.  When an outbreak occurred that year in Hong Kong, because of the spillover threat from animals, the director of the Hong Kong health department gave the order that all the chickens in Hong Kong should be culled.  She is given credit for eliminating the threat.   That Hong Kong health director at that time was Margaret Chan, who later became the Director General of the WHO.  As it turned out, that virus receded and did not pose an immediate threat, though it was still out there.

Then in the early 2000s, Avian influenza cases began to appear again, in Egypt, Indonesia, Africa, China, Vietnam, Cambodia, and elsewhere.

A concurrent trend was that the number of spillover events began to number in the hundreds.  And it became clear to everyone that whether it was H5N1or another virus, the question of a widespread, potentially lethal pandemic became “when, not if.” Consequently, interest grew in preparedness.  The UN created this little unit and the US began to invest in preparedness:  Sending large amounts of money to FAO, WFP, and WHO.

One track was to fund UNSIC and another to fund NGOs to reach the more peripheral parts of countries.  The major donor was the Division of USAID that was headed by Dennis Carroll.  And the State Department also began a pandemic preparedness operation.  John Lange was the U.S. Avian Influenza and Pandemic Ambassador in charge, and he had regular weekly meetings with representatives from USDA, Homeland Security, USAID, State, CDC.

At the same time the CDC began ramping up its own pandemic preparedness.  This must have cost hundreds of millions of dollars.

The USAID program, one that included the NGOs, became H2P, or Humanitarian Pandemic Preparedness, and that’s what I headed up.  There was a lot of procurement of PPE that has lasted to this day, stationed around the world.

USAID’s Office of U.S. Foreign Disaster Assistance [OFDA] had a big hand in that.  We in the USAID Global Health Bureau worked closely with OFDA as well, recognizing that OFDA’s mandate is principally for response, and that their involvement in preparedness was a reach.  It was very frustrating to us working in global health, working on the preparatory aspects that we could never quite get OFDA to deviate from its strict response mandate.

There is one report, the culmination of H2P, that grew to be a small movement, Towards a Safer World.  [http://www.towardsasaferworld.org/?q=content/what-tasw ] There is a monograph with that title that formed the basis of a large meeting held at WFP in Rome which culminated in a large multi-sector meeting in in 2009.  It remains available on a website with the same name.

What are five or so books about pandemics you would recommend?

RW:  I think that the best one would be Camus’ The Plague “La Peste:”   A perfect achievement.

I would also recommend John Barry’s “The Great Influenza”; Pale Rider (The Spanish Flu and How it Changed the World) by Laura Spinney; Sonia Shah’s “Pandemic: Tracking Contagions from Cholera to Ebola and Beyond”; Jonathon’s Quick’s “The End of Epidemics”; and David Quammen’s “Spillover,” which focuses on zoonoses and how pandemics can start.