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Unintended Consequences from Pushing for Sustainability of HIV/AIDS Programs

December 12, 2008

"Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime."This Chinese proverb has been the mantra of sustainability in the development business. It makes sense. But, oh, it can go so wrong. A recent paper by Ann Swidler and Susan Cotts Watkins looks at 10 years of research on development aid to community-based organizations dealing with HIV/AIDS in Malawi and shows how following this approach has led to some rather dismaying outcomes. In particular, they note that Malawians "know how to fish." What they lack (and this is my view after reading the paper) is access to fishing poles or fish. But this doesn't keep foreign donors from insisting on paying for training.Swidler and Watkins follow the logic of the "sustainability" mantra to show how incentives at every level "from the international donors to the national elites, interstitial elites and local population" make funding for training (and training of trainers) the dysfunctional outcome of an otherwise well-meaning effort. The donors can claim they are "teaching the population to fish," the national elites get income and status from managing and negotiating the programs, the interstitial elites (usually young high-school-educated volunteers) get contacts and opportunities to rise socially and economically, and the local population gets .. well, relatively little.(By the way, one of the particular joys in reading this paper was to see good qualitative research work which is interpretative and gives meaning to their analysis of incentives. And it isn't anecdotal because the authors show how their illustrations are grounded in a larger body of systematic interviews.)Swidler and Watkins make the case for what is really needed quite clearly in their final remarks:"It is hard to say precisely what constructive recommendations follow from the perspective we have offered here, but we do have several suggestions. First, the ideal of sustainability is a convenient self-delusion for funders and they would do much better if they could systematically and rigorously determine what projects are effective and then sustain them by paying local workers to actually do good--provide health care, sell discounted seeds and fertilizers, treat STIs, provide ARVs, supply children with books and school uniforms, or care for the ill and elderly (Kremer & Miguel, 2007). Second, since few of the approaches to AIDS prevention currently in vogue have shown any measurable effect (Potts et al, 2008), we encourage funding that responds to Malawians' desire to take care of the vulnerable in their communities, provide for their children's futures, and build economic security, independent of the issue of HIV and AIDS. Indeed, reading the proposals that Malawian villagers submitted in their usually vain attempts to gain access to AIDS funding convinces us that villagers do know what they want, but little of it is training in how to prevent, mitigate, or treat AIDS. The first two they already know how to do as well as the experts who try to advise them (Watkins, 2004), and treating AIDS has to be done through the health-care system."Finally, we suggest that donors consider the "hidden curriculum" their procedures teach. Requirements for elaborate proposals, bank accounts, and monitoring and evaluation might better be replaced by simple procedures that would funnel more resources to villagers and less to monitors. Such resources would create continuing projects that both villagers and employees (perhaps the brighter, more successful of the villagers' children) might rely upon. Rather than projecting a social imaginary that they find morally gratifying, donors and NGOs might provide opportunities that could sustain the realistic aspirations of those they claim to help."

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CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.