On the other side of the table: my views on aid effectiveness in Liberia

by Ryan Callahan

It's like...trying to drive a train into a lunchbox. It's like...trying to catch a meteor with a baseball
mitt. Wait, this is it. It's like...trying to fill a water balloon with a fire hose. What am I talking
about? Well, foreign aid flows relative to the capacity of a developing country's human resource
base to absorb them, to be honest.

One question I've been quietly considering during my time here is this: am I an aid skeptic? It
occupies my thoughts in between "where is the nearest air conditioned room?" and "how did I
end up here?" On one hand, I've grown appreciative of foreign aid because I've seen projects
completed whose benefits wouldn't otherwise be there. I know how much the Government of
Liberia can afford to allocate to the hospital where I work, and so I know what would never have
covered by their budget. We wouldn't have a pharmacist if not for the Nigerian government.
Nor the new nursing school building, from USAID. Nor a renovated maternity hospital, thanks to
$11 million from the Japanese aid agency, JICA.

It's comforting to have some feeling that shortfalls in funding for drugs, equipment, or facilities
will be plugged by someone, somehow. And there is no shortage of donors, who range from the
IFIs to private individuals to small NGOs to national governments to Mormons--the Church of
Latter-Day Saints provides over 300 new wheelchairs yearly to the Monrovia Rehabilitation
Center. Sometimes we ask for things from donors, other times donors ask us to take things.
It‘s a big task to supervise so many interactions, and while the meetings and negotiations
usually benefit the medical center, they also take away time from mentoring staff, formulating
strategies, and monitoring performance. So right away, you can realize that there the
management is forced to focus a disproportionate amount of its attention externally, even if it's
just a small amount to many parties, creating a distraction from the internal management of
people and resources. But is it worth it?

I have the somewhat unique position of being able to see the donor-recipient interaction from
the recipient's point of view, immersed in a fully Liberian institution where I rarely see other
Americans. In this role, I am privy to the kinds of conversations that donor representatives are
less likely to hear. By that, I don't mean that we're deceptive in our dealings with partners. I'm
talking about conversations on projects that have long had their final stamp of approval, are now
old news to their donors, and have broken down in one way or another. I'm talking about
appreciating the crushing frustration that broad structural factors elicit in right-minded
government officials, phenomena like the societal trauma of war or large-scale brain drain that
no single project can change. Most of all, I'm talking about human resource capacity. It‘s not
that the hospital doesn‘t need more money to run, and it‘s not that we shouldn‘t have better
facilities. Those hurt, but we can manage. But if you don‘t have an orthopedic surgeon, you
don‘t have orthopedic care. Period. Having the right people in the right places is hugely
important to Liberian institutions, yet this seems to be poorly understood by donors who are
content to make loans, fund programs, or build facilities without serious consideration to the
people they will touch.
I think that the particular brand of aid skepticism I‘ve adopted from those conversations is (1) a
doubt that donors in Liberia can make meaningful contributions to institutions or infrastructure
while there remains a severe deficiency of trained, experienced, professional civil servants and
(2) a doubt that training programs within traditional development projects can address this
deficiency on an ad hoc basis.

How much aid a health care institution or even a country can "absorb" depends on two things,
as far as I can tell. First and foremost, the pre-existing capacity in the professional staff, support
systems, and management. Second and to a much lesser degree, the capacity that
development aid can build intrinsic to the projects themselves. So in theory, these constraints
are what experts in "sustainable development" ought to have mastered. But instead, the
capacity constraints are often treated as fungible in project design, and more project support,
not less, is their answer. To use a mechanical example, if there is not enough power for an
advanced piece of equipment, the answer of an aid agency might be to build a generator, not
seek out a different piece of equipment or a different solution altogether. For the recipient, the
introduction of the generator brings a whole another level of risk to the project‘s sustainability--
maintenance, theft, fuel costs--that the donor agency will never have to see or deal with.

Many donors appreciate this and in my experience, aid workers are not ever as clueless as they
can be caricatured as being. But they can be victims of the structures within which they
operate. Guidelines, for example, can demand ―state of the art‖ equipment or even the local
purchase of products in the donor country. Under strict timelines and budgets, headquarters
can demand field officers to disburse more money, faster, to get more easily reportable results.
Nowhere is this inflexibility in policy and oversaturation in quantity more evident than in the area
of human resource capacity.

I found out recently that a donor, upon hearing that a recipient‘s capacity for procurement was
unsatisfactory, provided funding and directed the recipient to contract with an outside
procurement firm. To the surprise of absolutely no one except potentially the donor, they ran
into some trouble procuring the procurement firm. I would have laughed, if it weren‘t so
depressing.

Often, it is no secret that the recipient‘s staff is underqualified; perhaps rectifying this is the
purpose of the project. But like the lack of electricity in the previous example, human resource
constraints are rarely treated as static, a priori truths that give donors cause to reconsider their
plan or even abandon it. Instead, they are an invitation for training or contracting, or both, which
try to, if you‘ll indulge the metaphor, stretch the water balloon across the mouth of the fire hose
so it appears to be ready to catch the water. You can delude yourself into thinking that the
capacity to sustain a project is there, and you can delude yourself into thinking that the balloon
will be filled up gently and perfectly, if you try, but in reality it‘s going to break, because it‘s not
made to handle it. So make a bigger balloon! Reinforce it with wire and Mylar, we say. Didn‘t
they fill up condoms with water in Vietnam? Let‘s do that. Get me 8 million condoms, right
away! Let‘s adapt the capacity to the project, not the other way around. Rarely does someone
suggest scaling down, finding a garden hose, and turning the tap on slowly.
Part of the beauty and goodness of aid work is its ambition and refusal to be satisfied with the
status quo. That‘s why I like it. Limitations are made to be overcome, that‘s what our social
ethic teaches us. We don‘t let anyone ever tell us we can‘t do something. This is great for
leadership, it‘s great for planning and speeches, but it is catastrophic in project planning
because what happens is the water balloon breaks, if you can even stretch it over the mouth of
a fire hose, and the water ends up on the floor, and everyone wasted a lot of time and energy
administering the Water Balloon Project.

It‘s not popular to talk about, but I think it‘s worth examining why the constraint exists. How
exactly did the people judged to be inadequate to perform a task come to be that situation?
Both systemic and individual factors contribute to a lack of capacity, factors which will have a
dramatic impact on the success or failure of the training program designed to fix it and in
particular, the sustainability of that program. Evaluating these circumstances needn‘t be a value
judgment on the ―quality‖ of the workers or the country; it can provide some honest insight into
what sort of training and what sort of programs are more or less likely to work sustainably if
done carefully. In project design, we ought to ask if the program is tailored to the realities of
human resource capacity, as long as the conclusions we reach about that capacity are
accurate, prescriptive, and impactful. To illustrate what sorts of dynamics I would be sure to
include in this analysis, and not claiming expert knowledge on Liberian society, I will give some
examples based on my experience.

First, Liberia‘s education system itself is in perhaps worse disarray than its healthcare. It is a
severely damaged sector whose reconstruction cannot be accomplished without phalanxes of
teachers, who themselves must be (a) educated at all (b) trained to teach (c) paid a competitive
wage and (d) monitored and evaluated to ensure that students are actually learning anything.
Not to mention the (e) upkeep of facilities and (f) technical craft of writing curricula. And our
own education system in America is frequently derided as broken because executing (c)-(f)
turns out to be really difficult. Not only that, but the large and diffused education sector can be
and was for many years exploited for personal gain by teachers who give grades for money or
officials who graduate unqualified students, avoiding confrontation with their parents in a society
in which group cohesion is held paramount. 56% of the citizens of Liberia are functionally
illiterate, according to the national Poverty Reduction Strategy. For those who are literate, not
all will have a high school education. Fewer still will have a college education. Even those who
do cannot be reasonably expected to have all the benefits of a well-staffed and well-funded
educational system.

Second, the most educated segment of society that are most likely to be found working in the
public sector do not live in a vacuum. They are likely to be supporting their extended family,
making job security a first-order concern. But instead of creating leverage for supervisors to
compel behavior ―or else‖, the social structure disincentivizes behavior that would put anyone‘s
job security at risk. Misdeeds and poor performance go unreported, because the social logic
dictates that if no one tells on anybody, then everyone keeps his job. Supervisors are also
susceptible to these pressures, especially if their supervisor is a foreign consultant or anyone
who may not be around in the long-term, unlike their social peers, who will certainly remember
being thrown under the bus to curry short-term favor with an outsider. Even if the supervisor
can be fired for failing to report wrongdoing, the probability that there is someone qualified
available to take their position quickly is low, not to mention that the documentation necessary
to carry out such an action is probably in disarray.

Third, ―training‖ means by definition that you‘re trying to induce some kind of behavior change.
At minimum, you‘re instituting something new in a vacuum, but there is almost always
something else being displaced, even if that‘s just idleness. Idleness, as anyone who has ever
spent some time on a couch knows, has a certain power of inertia to it. But even more powerful
is the call of past precedent and familiarity. So behavior change needs to be propelled and
maintained by something, like an incentive or punishment or broader buy-in into a larger idea.
All of this converges on the shoulders of leaders of the organization undergoing some program
of behavior change, a person who will be ultimately responsible for the institutional adherence to
a new protocol.

In a society whose historical power structures were based on powerful chieftains, this leader will
probably be pulled in twenty different directions by twenty different problems ―requiring‖ his or
her attention in a given day. The lower priority tasks will be the first to be neglected, not out of
malice or negligence but by necessity. Whatever monitoring protocols are supposed to be in
place to give rewards, mete out punishment, or revive morale could be sacrificed for legitimately
higher priorities, at least in the short run. What‘s more, whenever that person is absent from the
workplace or the country, employees are liable to interpret the situation as license to abandon
protocols, because they are associated with that leader and not the institution broadly speaking.
Liberian executives often travel, to visit families still in America, to raise money abroad, or to
visit hardly-accessible regions up-country, leaving deputies in charge who are unaccustomed to
the top role and unwilling to take actions that could risk reprimand upon the leader‘s return. It‘s
easier to plead ignorance than to defend actions taken. Hear no evil, see no evil, speak no evil.

So in my own amateur analysis, the human resources environment is one where overburdened
executives are kept uninformed by co-opted supervisors and reticent employees, most of whom
were denied a quality basic education. We ought to treat these as legitimate concerns and
serious restraints, not deride them as generalized corruption or even laziness. And we haven‘t
even talked about Liberia‘s social trauma from the war, inadequate salaries, stultifying formality,
or aversion to written communication. Not to mention the slower pace of work and minor
frustrations that Western professional society has long moved past. Can you imagine if the
electricity at the office were turned off every day at 5:00pm and the air conditioning worked only
sometimes? Or if your BlackBerry fell silent because none of your immediate reports had e-mail
access? What would that do to productivity?

I could be preaching to the choir here, or maybe just naïve, but I‘ve got to believe that someone
is looking at these things on a micro level and using them to inform the design of aid projects on
a micro level. That someone realizes that the projects most likely to succeed are the ones that
require the least disruption to social cohesion, the least attention from leadership, the lowest
possible standard of education, the longest time frame, and so on. But the amount of waste and
lack of appreciation for these challenges I‘ve seen suggests otherwise.
All this is packed into my own doubt that we can accomplish what we want to accomplish in the
time we allot, in the way we‘re accustomed to operating, and with the intention of creating a
sustainable change. If it involves people, training, behavior change, monitoring, evaluation,
forget it. Not the whole project, just our expectations for it. I know that we want to set a high
bar, to respect our partners by maintaining high expectations, and I support that attitude in the
long-term. In project design, in the medium-term, pragmatism must be privileged, and not just in
projects tempted to make grandiose promises like ―we will create a knowledge-based economy‖.
This pragmatism needs to infiltrate the smallest projects, too. If we want to donate an MRI
machine, we need to first assess the human resources capacity to install it, recommend its use,
operate it, maintain it, secure it, and so on and wean ourselves off our addiction to shiny objects
with LCD screens. The question shouldn‘t be ―do you need this?‖ because the answer is almost
always yes. The question should be ―will it do any good?‖ and the answer needs to be informed
by an honest and comprehensive assessment of the human resources environment surrounding
the project –everyone who matters, maybe even right up to the President of the Republic.

I don‘t suppose any of this will be new to anyone working in aid as a career. I write about my
experiences here primarily for friends and family who aren‘t inundated with these arguments on
a daily basis. I think even the American public is increasingly cognizant of the debate over aid
effectiveness and my personal experience might augment whatever they already know. I don‘t
think it‘s too much of a leap to suggest that we‘ve ignored human resource capacity for quite
some time, evidenced by the water and broken water balloons all over Africa‘s collective floor.
Today, Liberia is celebrating the forgiveness of $4.6 billion dollars in loans given to Liberian
governments only too willing to bankrupt their successors and steal from their people, a reality
we ignored to the peril of the Liberian people. Clearly we gave no serious consideration to the
capacity of those people, in their positions, to complete the project as we expected—that is, to
pay back the loans. The international community constantly calls for more and more aid, and
the OECD has recommended that 0.7% of national GDP be the target level for national
governments, a figure that apparently did not take into account at all the ability of recipient
governments to absorb that aid. The story I‘ve heard is that the World Council of Churches
recommended a 1% tithe based on Biblical calls for charitable giving and the OECD said ―ehhh,
how about, say, 0.7%‖? If that‘s even half true, it helps explain why we‘re holding a fire hose
when we need a pipette.

So can we readjust goals and expectations to smaller, longer, less glamorous projects? I doubt
it—it‘s not the way the foreign system is set up and in keeping with our theme here, I don‘t want
to call for something that can‘t be done. The development community, in the Paris Declaration
on Aid Effectiveness, called for aid to be distributed through national budgets, a suggestion that
I think attempts to allow governments to fund the sorts of small, long projects that can be most
beneficial. But again, is this something that budgeting agencies, legislatures, and national
governments are prepared for? Will it do any good? Isn‘t it worth preserving aid agencies‘
institutional contacts and expertise as program implementers or should they just be in the
business of writing checks made payable to the Treasury of the Republic of Liberia? I don‘t
know.
What we are left with is the incremental task of building up the managerial and technical
capacity of an entire national workforce, especially in the public sector. I think the viability of
projects in all sectors depend on the success of this grand project. It has been suggested by
some development scholars that we consider, as an aid project, allowing increased numbers of
people from countries like Liberia to attend American universities on student visas. There is a
lot I can find to like about this idea, particularly the prospect of having young, skilled civil
servants under contract with the government gain exposure to high standards of performance
and accountability and reimagining the supervisor-report interaction. Of course, it has its
problems too, but it represents the sort of creative and original thinking that might improve the
situation and seems all too rare.

I guess I am an aid skeptic, because I‘ve seen the hospital get burned one too many times by
projects that could have worked out so well, but ended up useless, including the hospital itself,
which was an aid project in the ‗60s and closed completely several times, last in 2001. I‘m an
aid skeptic because I think that will lead to better aid results and programs we can truly be
proud of working for. And I‘m an aid skeptic because I think that attitude promotes honesty in
planning and practicality in choosing projects that can be accomplished, not just projects that
can be funded. Because it‘s not getting the money flowing that‘s the problem. It‘s finding a
place to point the fire hose when all we have is water balloons.

The views and opinions expressed here are mine alone.