Lifeblood

Home > Nonfiction > Lifeblood > Page 18
Lifeblood Page 18

by Alex Perry


  The campaign also confirmed Jeffrey Sachs was right: health and prosperity were linked and the key to Africa’s upward trajectory. Five of the ten African countries that had halved malaria—Botswana, Cape Verde, Namibia, South Africa, and Swaziland—were among Africa’s eight middle-income countries. (The other three are Mauritius, the Seychelles, and Lesotho, all of which are already malaria free.) Four of the five other countries were also among those whose GDP was growing the fastest: Madagascar grew an average annual 5.7 percent from 2004 to 2008, Rwanda an average 8.6 percent, São Tomé and Príncipe 6.1 percent, and Zambia 5.8 percent. (The exception was Eritrea, where an autocratic ruler was able to dictate action on malaria, even while his country shrank under diplomatic and economic isolation for its support of Islamist rebels in Somalia.) If the World Malaria Report had included statistics from 2010, it would have found Ethiopia had also halved malaria by the middle of that year, all the while managing average annual economic growth of 11.8 percent from 2004 to 2008.3

  There was still a problem with Africans relying on others to fix their problems. But ALMA was one answer to that, with the potential to transform how all assistance was delivered. And after all the scandal and controversy that surrounded aid, Chambers’s results promised reinvention and deliverance. He had achieved his success working with the big aid institutions that were so often the target of criticism. They could now replicate their success in other campaigns. Tony Blair, whose Faith Foundation was assisting the Muslim-Christian collaboration in Nigeria, told me the malaria campaign was “about as good an example as you get” of how “the nature of help is changing” and how that, in turn, was “rebalancing the respectability of the aid case.”4

  Proof of that came in how the aid world was increasingly adopting Chambers’s ideas. At the WHO, Margaret Chan said he helped inspire her to reform her own organization. “I come from Hong Kong,” she said. “Very entrepreneurial. Anything goes. Businesses serve people well, and they move with the times. But the WHO was born sixty years ago. When I first joined, I kept asking myself: is it still relevant? Clearly, it should be able to move faster.” Watching Chambers, she said, “it dawned on me. I should leverage Ray. I should use his network and his ability to use good business sense at the WHO.” Writing a malaria business plan for the WHO, with targets and deadlines, had set a particularly useful precedent. “Eradicating malaria is an ambitious goal, a dream even. But if we hadn’t demanded that, scientists and aid professionals would never have gone back to the drawing board. We would just have continued as before.”5

  Likewise the British and US governments, the two biggest funders in malaria and all aid, are also following Chambers’s example. In January 2011, Rajiv Shah, head of the American agency USAID, announced that Washington wanted to see a transformation of aid into something more “businesslike.” USAID conducted nearly five hundred independent evaluations of its work in 1990, said Shah. That fell to a hundred seventy in 2008, despite a threefold increase in programs. Often the evaluations were commissioned by the aid project itself—“a relationship between implementing partners and evaluators akin to that between investment banks and ratings agencies”—and followed “a two-two-two model.” “Two contractors spending two weeks abroad conducting two dozen interviews. For about $30,000, they produce a report that no one needs and no one reads. And the results they claim often have little grounding in fact. One of our implementing partners . . . claimed over a quarter of a million people benefited from a $14,000 rehabilitation of an Iraqi morgue.” USAID needed to move beyond “updat[ing] the traditional version of an aid agency. Instead, we are seeking to build something greater: a modern development enterprise.”6

  The next month, the British International Development Secretary, Andrew Mitchell, announced that London would also “focus ruthlessly on results,” cutting £50 million of funding to aid agencies it considered poor performers and boosting support to star performers. In Ethiopia his department was setting up the first ever “cash on delivery” aid project, a scheme to enroll girls in school in which funding would be released only when results were achieved. “From now on we will only give aid where we can follow the money and ensure that the British taxpayer is getting value for money,” said Mitchell. “Most international organisations are doing a decent job but some need to be shown the yellow card. Others will, frankly, get the bullet.”7

  The implications beyond aid were no less profound. The campaign had given religion a new pragmatic purpose on which it might base a revival, something understood by the Methodists in the US, who pledged to raise $75 million for the Global Fund.8 In Nigeria, it had given Christianity and Islam a cause around which they could unite and overcome their bloody rivalry.

  What worked for God worked for Mammon too. Victoria Beckham suddenly had a point. And if aid was becoming more businesslike, business was becoming more aidlike. In the winner-takes-all boom that began in the 1980s, the winners had ended up taking an awful lot. Chambers amassed hundreds of millions of dollars. Bill Gates and the financier Warren Buffett accrued fortunes several times larger than those of entire nations. Chambers had been one of the first to make the switch from narrow personal gain to enlightened self-interest in his own life. His campaign was pointing the way forward to a new, inclusive way of business. In particular, he and his team had cast a giant bed net around the world, a statement of inclusion without parallel.

  Malaria was opening the doors to a gentler, more inclusive world. Business now had a way out of the resource curse. Fighting malaria was proof that helping others less fortunate ultimately helped everyone. Yawning inequality wasn’t just bad taste but bad business. Unfair was one thing. Unwise was something else.

  Those ideas are becoming ever more common in business. Profits remain a priority, but many CEOs now view them as something unlikely to be maximized in isolation. The lone buccaneer is out. In are companies that see their future prosperity as best guaranteed by membership of a prosperous, healthy society. The new mantra is “doing well by doing good.” Fashion giants such as Nike now take notice of conditions in the Asian factories where their sneakers are made. Organic certification has moved from niche to mainstream supermarket fare. McKinsey, the consultancy, now has a division researching poor-world development. De Beers forswears blood diamonds. Discussions at the elite business forum the World Economic Forum in Davos, once dominated by talk of personal profits and narrow opportunity, now take a wider view of return on investment, one that encompasses development and poverty alleviation. Talk at the Forum’s January 2011 meeting was even dominated by the issue of inequality and its corrective, inclusion. The fury that Western bankers and their bonuses attract is best understood in this context. It’s not just the amounts of money involved. It’s the ethos of exclusivity—personal reward defined solely in returns to the individual—that is increasingly out of step with the times.

  Likewise, we are now in a new age of philanthropy. Some call it philanthro-capitalism. Bill Gates calls it creative capitalism. Whatever name you use, it is dramatic. Rather than drip-dripping donations away in perpetuity as earlier foundations tended to do, the new philanthropists aim to give away most of their money in their own lifetimes and all of it within a few decades. This high-impact approach is measured in some extraordinary figures. According to one study, overall private donations in the US hit a new record of $306 billion in 2007—around a third of the value of all car sales in the US that year.9 In 2008, the Index for Global Philanthropy found total private US foreign aid was $37.3 billion, $10 billion more than the US government sent overseas.10 The trend has been most marked among the richest of the rich. In 2006, twenty-one Americans donated at least $100 million each to charitable causes, nearly double the number that did so in 2005. A fresh high came on August 4, 2010, when Gates and Buffett persuaded forty of the world’s richest—among them Oracle founder Larry Ellison, Citigroup creator Sandy Weill, Star Wars director George Lucas, media mogul Barry Diller, and eBay founder Peter Omidyar—to announce they w
ould all be giving away at least half their fortunes, much of it to the developing world.

  The new mood also extends beyond business. With its central argument that we—different races, different animals, even different insects and plants—are all part of the same world, the environmental movement is a standout example of the new inclusion. So is the technological tool of the age, the internet, which was founded on collaboration and freedom, and whose most popular products and services are often free.

  Politics too is changing. A generation after Margaret Thatcher told Britain there was “no such thing as society,” her successor as Conservative Party prime minister, David Cameron, promised to inaugurate the “Big Society,” a nation that had volunteerism, local democracy, and collective social responsibility at its core. French president Nicholas Sarkozy proposes ending measuring a country’s wealth in the narrow count of euros denoted by Gross Domestic Product and using something more ephemeral: Gross National Happiness. In China, the annual session of the National People’s Congress in March 2011 declared that a “happy China” was more important than a rich one and enshrined that as the goal of its new five-year plan. In the US, critics accuse President Barack Obama of extending socialism with his health care reforms. In reality his policies are not communist but communitarian, based on the belief that a country’s cohesion is key to its welfare and prosperity and something for a government to encourage with national infrastructure like roads, waterworks, power, and, yes, a minimum standard of health care.

  Chambers performed his own transformation as long ago as 1985. He was one of those who launched the get-rich-quick era. Within a few years, he was leading attempts to rectify the inequality he helped create, arguing it was ultimately in his own interest. At first, he was simply figuring out a new way to be in the world. Today it can seem as if he was sketching out a new way for the world to be.

  And yet the climax of the campaign that defined the new inclusion—the December 31, 2010, deadline for universal malaria bed-net coverage—passed largely unnoticed. There were reasons for that. Chambers and his team ended the year on a sour note when he had to make an emergency visit to Zambia. The country had cut malaria deaths by 66 percent by 2009. But allegations of corruption in the health ministry had surfaced, and in June 2010 the Global Fund froze $300 million in grants. As in Kenya, that meant millions of expiring nets would not be replaced. Crisis loomed. Once again, Chambers secured alternative funding of $30 million from the World Bank, but not before malaria rates began to climb.

  The Zambian allegations, however, turned out to be the harbinger of something even worse. In January 2011, the inevitable finally happened: malaria got busted. As well as the $3.5 million in undocumented spending and $7 million on “unsupported and ineligible costs” at the Zambian health ministry, the Associated Press revealed an internal Global Fund investigation had found:• $4.1 million—67 percent—of money spent on an anti-AIDS program in Mauritania disappeared in “pervasive fraud.”

  • $4 million of $22.6 million spent on a malaria and tuberculosis program in Mali was stolen using “rampant” forgery.

  • 30 percent of grants to Djibouti were misused to buy cars and motorcycles, while $750,000 simply disappeared.

  Accusatory headlines alleging fraud in the world’s biggest aid campaign—“Gates’s and Bono’s favorite,” said many—appeared in almost every newspaper and on every website in the world. The Fund announced a panel of experts to examine the Fund’s ability to fight fraud and plans to raise its inspector-general’s resources from $3 million and two assistants to $19 million and thirty assistants. Bill Gates tried to defend the Fund, noting that the missing money concerned less than a third of 1 percent of the Fund’s grants and the Fund had uncovered the fraud itself. But, as he added in an interview with the Associated Press, the adverse publicity might mean “people will reduce their generosity—and that causes deaths.” He was right, at least about the first part. Sweden suspended its annual donation of $85 million. Germany put a stop on its pledge of $250 million.11

  Meanwhile, throughout 2010 Chambers had also been forced to confront his own uncomfortable reality: he was going to miss his target. Originally, he’d set himself the goal of distributing 300 million nets to 600 million people by December 31, 2010. And he did that, or very nearly. By year’s end, 289 million nets had gone out to 578 million people—an astonishing 300,000 nets delivered every day for thirty-two months.12 What’s more, surveys showed that 80 percent of the nets were being used.13

  But the goalposts had shifted. Estimates of the numbers he needed to cover had risen during the campaign, first from 600 million people to 700 million, then to 765 million. That meant Chambers had to hand out another eighty-three million nets at a cost of a further $830 million—and he spent much of the year in negotiations with net manufacturers. In the end, he found both the nets and the funding, but not in time to meet the deadline. Distribution was complete in South Sudan and Ethiopia. It was unfinished in Kenya, Nigeria, Tanzania, the DRC, and Uganda—where the government was still adamant about buying only African nets, even if they were slower to arrive.

  Again, Chambers didn’t miss by much. The nets were paid for, ordered, or in place in all those places. Kenya, Uganda, and Nigeria were expected to have completed their distributions in the first half of 2011, which would bring net coverage up to 90 percent. The DRC, the eternal laggard, was not expected to do the same until September or October. But even that failure contained a valuable lesson: the DRC was doable. “Five years ago, no one would touch this country with a barge pole,” said Basu. “People would simply concentrate on working with the blue-eyed boys of development, like Tanzania. Enough international goodwill to fully fund every net that the DRC needs was unheard of. But Ray managed to get traction behind the DRC in a way that made it impossible to ignore any longer.”14 Alan Court said both South Sudan and the DRC had proved “counterintuitive.” “There is a huge desire to have these nets,” he said. “The people know about nets, they know how to use them, and they want them.”15 In an environment of desperate need, all it took to make an enormous change was a few people with the right resources. “When the history of malaria is written,” commented Steven Phillips, “it’s going to be one about a few key leaders.”16

  Universal coverage would still be achieved, just later than hoped. Yet when I spoke to Chambers at his home in Morristown, New Jersey, on December 28, three days before the deadline expired, he was subdued. “Every day we delay, we are losing hundreds, perhaps thousands, of children,” he said. “The house is on fire until we get everybody under a net. It’s very frustrating. We could have reached full coverage by the end of the year. We did not, because of inexcusable delays. I hate the thought of losing those children.”

  The sense of deflation was increased by the realization that 2010 was not the end. Over that last year, Chambers and his staff had struggled with the gnawing suspicion that their deadline was artificial. In reality, there was no finishing line with malaria—at least not for decades. Whether ALMA took over or whether Chambers and his team remained in place, the campaign had to go on. “When we began to think about replacement nets—that all the nets we’d handed out would be expiring after three years and sprays would have to be repeated annually—that was really difficult to get our heads around,” said Basu. “It meant there was no actual state of universal coverage. The nets constantly expire. There is no moment you can stand still. This was a remarkably ambitious and hugely successful public initiative. But we had to go through three or four more cycles of nets and spraying at least before there was a decent hope of eliminating malaria, and more like six or seven in the worst places. It was like we’d been climbing this mountain for so long and when we finally get to the summit, we see four more peaks ahead of us. It’s not what you expect. You expect to be elated, maybe raise a glass of champagne. And it was: ‘Shit! We’re exhausted! And there’s another four mountains!’”

  The team left their offices for Christmas in a mood
of anticlimax. “I was sitting in the office on December 23,” says Basu. “We have these little countdown clocks on all our desks, and I was looking at them and talking to Tim. And I said, ‘There is going to be no great moment, you know? This is not a bang. It’s a whimper.’ The feeling was just one of exhaustion. We’d had this mad focus for more than two and a half years, the last few months had been really tiring, and then Zambia was just a tough way to end the year.”

  A few of the campaigners were celebrating. A year before the deadline, Chambers’s Malaria No More cofounder Peter Chernin had warned against expecting 100 percent. “Perfection is the enemy of good,” he said. “Will we cover every single person with a bed net? Honestly, I doubt it. Will we have a bigger impact than any other campaign ever? Yes, I think we will. You set lofty goals, and if you get 90 percent, that’s a great achievement, and you focus on getting the remaining 10 percent done as quickly as you can.”17 Others could barely contain their glee. “It’s unbelievable,” said Tachi Yamada at the Gates Foundation in December 2010. “It’s amazing. In parts of Africa, malaria is absolutely going away. It’s testament to what the world can do if it really wants to.”18 Christian Lengeler of the Swiss Tropical Institute was little short of ecstatic. “It’s a wonderful feeling, I tell you, to be able to contribute to this,” he said. “It’s great! Malaria was so big, it was felt there was nothing we could do about it. People said we were not going to change anything. It’s such an extraordinary story.”19

 

‹ Prev