By Morris DC Komakech
The debate raging between top American entrepreneur and former Microsoft CEO, Bills Gates, and the world celebrated micro-economist, Jeffrey D. Sachs of the Earth Institute at Columbia University touches on the core of Global Health. (Refer to Uganda’s The Independent magazine: Why Jeffrey Sachs matter by Bill Gates and; Why Bill Gates gets it wrong by Jeffrey Sachs – May 31, 2014). These debates provide an indictment of the Millennium Village Projects – a brain child of Jeffrey Sachs in his quest to end poverty in Africa. In reality, this debate is an indictment of all foreign interventions that have been conceived from western capitals or institutions and imposed on Africa.
Here, Bill Gates reiterates the critiques of the Millennium Village Project contained in a book by Vanity Fair writer, Nina Munk titled The Idealists: Jeffrey Sachs and the Quest to End Poverty (Published by Random House Inc, NY). The book reads very easily as a narrative in a novel but not as one of those methodological and glossy text books.
The debate between these two philanthropists is welcome in a world where transparency and imperialist agendas appears transposed. No doubts, both men have used their influence and resources very generously to attempt to better the causes of humanity and to liberate Africa from its sorry conditions of persistent hunger, ill-health, and poverty. Having dished out over US$28.6 billion in grants pay-outs so far, Bill Gates is perhaps, the most financially invested person in the world, in this struggle against dehumanising conditions in Africa and elsewhere – and that is where his leadership in Global Health matters.
Given the negative evaluation that the MVP is attracting, one needs to fully understand the problems with such programs. While they are ethically sound, well intentioned, meticulously executed, and located in places where they are most needed, they fail to deliver on their ultimate aims and objectives and instead exacerbate those same problems they are intended to resolve or rectify.
The MVPs were designed to improve living conditions in villages and to bridge the gap in social services where governments in those countries have failed. MVP goes into the populations, build health centres, schools, libraries, and teach modern farming methods and health education. They distribute mosquito nets, drugs, provide immunisation services, and extend communication systems in countries such as Malawi, to end isolation, in Dertu (Northern Kenya) where Ms Munk found it to be of no essence, they constructed markets – and did more.
The MVPs are a welcome intervention for theory testing, but it ends at that. The lessons that Jeffrey Sachs and his colleagues should have learned about Africa and such impositions are numerous.
The WorldBank/IMF imposed the much dreaded Structural Adjustment Programs which instead of uplifting African nations from debt achieved the exact opposite effect. Thereafter, every program, whether by the EU, US, or China imposed on Africa has continued to fail the sustainability test and collapsed the moment the dollar support is ended.
As scholars and global health leaders, the main areas of concerns before any investment is implemented should be about local buy-in and sustainability.
Often, these philanthropists do not pay much attention to any of the crucial factors such as cultural fit of their programs and the fact that human societies are not homogeneous, and that each program requires customising. Failure to include diversity in these theories, from a non-western calibration is also the beginning of their failures.
Interestingly for an economist like Sachs, he fails to understand the complex nature of poverty, its various tenets and manifestations. In general, he exposes why understanding the nature of African poverty has eluded many in the Western capitals.
This explains why Western-prescribed solutions appear to address universal poverty as experienced in the West as deprivation. An influential analysis of rural poverty in Africa was well articulated by Patrick J. Muzaale in the Journal of Social Development in Africa in 1982. In his seminal work: Rural Poverty, Social Development and their Implications for Fieldwork Practices, Muzaale explicates different typologies of poverty and those that are specific to rural Africa.
The MVP experience is perhaps the major lesson that Bill Gates and Jeffrey Sachs can use to teach the western world about the complex nature of poverty in Africa.
Nina Munk’s effort needs to be commended. Had she not been diverted by the obsession to critique the MVP too early, she could have done the most relevant work for the success of MVPs. Her initial intention was to capture the voices of the underprivileged recipients of the MVP whose inputs were excluded and yet were crucial. Without these voices, the MVP project will remain experimental and will collapse the moment the MVP dollars dry out like all other projects before it.
Morris Komakech is a Global Health researcher with interest in Maternal Child Health and HIV as well as Food Security, Water and Sanitation in rural Sub-Sahara Africa. Can contact via [email protected]