USAID Fights Malaria Blindfolded

Roger Bate | 20 Apr 2005
Examiner

Scientists complain that the press often misrepresent their work. Sometimes they have high-profile help--like the head of a federal agency. Fibbing to the public is one thing, but trying to pull the wool over the eyes of a senator can be quite another.

Sen. Sam Brownback (R-Kansas) was concerned that the U.S. Agency for International Development wasn't making enough progress in the fight against malaria--a disease that afflicts a half-billion people a year, killing a million of them. USAID administrator Andrew Natsios reassured the senator that the agency was making the right choices--picking ways to fight malaria that gave the most bang for the buck.

The argument was convincing: If insecticide-treated bednets cost up to $15 per person less than indoor residual spraying where insecticide is sprayed on walls in order to repel mosquitoes--and both were approved by experts as just as effective, why spend more money to get the same result?

But Natsios's assurances weren't entirely honest according to the very scientist whose work he cited. Noted South African malaria expert Dr. Brian Sharp says his work shows spraying is usually slightly cheaper than bednets, and nearly four times less expensive when DDT is used. "I don't know how they got their figures, but they should not be quoting us if they don't use our data correctly."

For those familiar with USAID, Natsios's gaffe is unsurprising, since the letter to Sen. Brownback, like most of the malaria work his agency does, rarely faces public scrutiny. For this sorry incident is entirely indicative of the complacency, and the lack of transparency and accountability that pervades USAID.

With the Bush administration dedicating unprecedented levels of funding for developing-worldhealth efforts, the need for reform has never been greater.

As a large bureaucracy with missions across the globe, organizational deficiencies are rife. The agency lacks information management tools any multi-national entity needs to be effective. A GAO report from 2002 found that USAID's ignorance of what projects it funds--even which countries they're in--prevents meaningful evaluation.

Despite such criticism, little appears to have changed. USAID staffers still have no centralized global tracking for ongoing or past activities, making collaboration with other development groups nearly impossible.

When it comes to transparency, USAID's performance is even worse. The Agency considers any information it deems "proprietary" off-limits. To USAID this means disclosures concerning a private entity and since nearly all work is done by outsiders, USAID discloses little.

Staffers and "partners"--organizations that win contracts or grants--complain the agency does not welcome outside criticism and goes too far to protect its image. For fear of losing their jobs or new contracts, insiders critical of USAID adamantly refuse to put their comments on the record.

Their fears are justified. In 2002 former USAID Chief of Travel and Transportation Shirl Hendley alerted superiors that agency travel practices violated federal rules. She was originally ignored by officials who benefited from the violations, but when she refused to stay quiet, they decided she had to go because, "you have chosen to do what you believe is correct, even if it contradicts the instructions you have been given." A subsequent investigation spearheaded by Sen. Charles Grassley (R-Iowa) vindicated Hendley and strongly rebuked top AID officials, including Natsios.

Over the years, the agency has made apparent efforts to improve data management and transparency, but agency rules that require officers to submit final reports to a public document repository still fail to produce meaningful evaluations. A 2004 internal investigation discovered staffers and contractors skirted disclosure rules by labeling evaluations "assessments" or inserting proprietary documents (like budgets) in order to win exemptions.

Perhaps its greatest shortcoming as an international development agency is that USAID embraces a contracting structure that keeps money inside the Beltway. It hands out big contracts to big development firms. Some of its contractees are often solely reliant on USAID money to stay in business and all of them are happy to lobby Congress to increase the agency's budget. Though the agency stopped collecting data on the prevalence of this practice, a budget officer familiar with the process estimates USAID spends 70 percent of its money on U.S. goods and services.

These weaknesses mean USAID often misspends funds intended to promote economic development and give assistance to poor countries.

To see why, consider USAID's malaria program. When members of Congress from both aisles expressed concern over the agency's use of increased malaria funds, USAID could not account for the bulk of its $80 million malaria earmark. After a series of congressional hearings, and demands for a Government Accountability Office investigation, the agency finally came up with an accounting sheet with numbers that didn't add up--literally.

Arithmetical weaknesses and vague phrasing aside, the document confirmed suspicions that USAID is squandering most of its malaria money: Only about 5 percent of the $80 million is used to fund the three interventions, treatment and prevention, that work. And the vast majority of that money is spent on nets. Malaria is a huge challenge--accounting for more than 500 million serious cases and yearly killing more than 1 million people, mostly women and children--yet instead of concentrating funds on a few places at a time, where good performance could be demonstrated, the agency spreads money thinly across the countries in which it operates, supporting staff careers. Indeed, of the 95 percent of the budget that doesn't buy actual products, most is hard to account for, although a great deal goes to nebulous items such as "technical assistance."

Natsios' claim to build capacity only holds true among U.S. contractors. Bits of the USAID network do work well, such as the Child Survival and Health Grants Program, which works "on the ground" with populations affected by disease and upholds strict monitoring and evaluation standards.

The cavalier use of science to deflect criticism by its boss reflects USAID's tendency to look after itself more than the sick poor in the third world. Its opacity and lack of accountability have become anachronistic. If the Bush administration wants public support for plans to increase aid spending, the least they can do is give the public some assurance their money will do some good.

Roger Bate is a resident fellow at AEI and director of Africa Fighting Malaria, a group that advocates more use of residual spraying. His coauthored paper on USAID will be published by AEI.

http://www.aei.org/publications/pubID.22336,filter.all/pub_detail.asp