Philanthropy

The White House and Congress reached a compromise on the PEPFAR (the President’s Emergency Plan for AIDS Relief) renewal legislation. I wrote about the controversies in this program last week. House Democrats have been wrangling with the Administration for the next 5-year AIDS relief program.

The Democrats (and most of the NGOs and HIV policy community) wanted to drop two PEPFAR requirements: that 1/3 of all the program’s prevention funds be spent on abstinence-only messges and that PEPFAR recipients pledge opposition to prostitution. They also wanted to be allowed to use PEPFAR money to support general reproductive health services.

Congress got some of what it was after. The 1/3 abstinence requirement is gone (although PEPFAR will have to report if non-abstinence or fidelity programming acounts for more than 1/2 of prevention funds.) That rule was always too cumbersome and illogical to use, and I’m personally glad that it is gone. What I’m worried about is that from what I can tell the ABC (Abstinence, Being Faithful, Condom use as appropriate) policy seems to have been further entrenched in US policy.

The PEPFAR policies have to be followed by all US-funded HIV projects (PEPFAR itself only goes to a small number of focus countries, USAID and other sources work to address the pandemic in a lot of other places). ABC sounds fine, and probably would be fine if it was used as a guidline within the US government reporting and project planning system.

But fear of getting on the wrong side of the more conservative members of congress makes the assistance managers responsible for HIV programming overly cautious, and too often the prevention materials our government pays for go to ridiculous lengths to push ABC. I don’t think anybody wants a copy of a condom use promotion leaflet to find its way to Washington without the protective words “Abstinence” and “Faithfulness”. That leads to sloppy prevention activities, and undermines the point of our assistance. We would all be better off if people on both sides of this issue could just take a deep breath and trust each other to be reasonable.

As for the other issues:

PEPFAR will now be able to take an approach to prevention that is tailored to each country. The funds can also now be used for “HIV testing and education in family planning clinics but not for contraception or abortion services“.

The prostitution rule will stay as is.
The final bill fund PEPFAR at $50 billion over 5 years (the President asked for $30 billion, and the first PEPFAR package was for  $15 billion).

The global prices of staple foods have risen 75% since 2005 - driven largely by rising oil prices. Unsurprisingly, this is a problem for poor. Among the other obvious problems, food aid agencies are also having trouble providing the necessary quantities of food. This will be a problem to watch over the next few years.

There was a good Op/Ed about social enterprises in the Guardian today. It was written by Rob Greenland, an experienced social entrepreneur with a good blog of his own, The Social Business. Rob talks about the hard realities of social business: competing in the market, charging for previously free services, surviving on grants and contracts. Although he is explicitly a social business enthusiast, he does want people to be realisitic about what it can and can’t achieve. We’d do well to keep the same realism with every new development tool (I almost used the word “fad”) that comes along.

The WSJ blogs posted yesterday about Patty Stonesifer stepping down as Gates Foundation CEO. They note that giving away $3 billion a year is a lot tougher than it sounds. That is certainly true. The post didn’t give contact information for those hoping to apply. But I highly recommend giving the comments a look.

Last week the Financial Times published an article about how corporations and non-profits can work together productively. The relationship is probably always going to be an awkward one, especially for NGOs that don’t want their corporate partners to make any money off the arrangement. The FT is particularly concerned with the division of intellectual property rights for innovations that come out of development partnerships. They list several models, but admit that this is an area that requires more work.

The Times of India has another example of what cell phones can do for a society. Through the website IndianBloodDonors.com people can now send a text message with their urgent request for blood. This is clearly a much more direct means of communication than first finding an internet-connected computer.

Getting the cell phone in the hand of the end user is just one necessary aspect of makin gthis work. Building the website and system of donors, screening the blood, and informing people of the available service are probably more difficult. But the new technology brings new opportunites.

The Economist commented this week on the recent controversies over the Gates Foundation’s global health work. The most recent example of this controversy was when the head of the WHO malaria program asserted that Gates is becoming a monopoly and driving inappropriate research in malaria.

Our Economist correspondent defends the Gates Foundation. In doing so, he (because all Economist correspondents are male, right?)  points out that Gates competes with other major donors like the US Government and the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria (GFATM). He also believe that Gates has the resources to fund comprehensive programs, and therefore the worry that their influence will limit a diversity of work is unfounded.

Ultimately, the Economist believes that the distrust of Gates is based in jealousy from smaller organizations, like the WHO. The presumption is that the UN wants to be the monopoly on policy, and that they are just being catty to resent the status that Gates now has.

There’s definitely something to that, but I think the WHO would say that it has the right to its special influence. It gains its authority from the General Assembly and is answerable to them. The Gates Foundation is answerable to Bill, Melinda, and Bill’s Dad (also named Bill). Isn’t that an important difference?

UN agencies are certainly hampered by their need to work within the demands of member states (sometimes being forced to publish only “official” data, for example), but there is also a value to their semi-insider status. Because they speak for the international community, the UN speaks with authority in the developing world and is able to influence policy in a positive way.  It is worth preserving that influence.

In closing, the Economist has this to say, and I think says it very well:

“A big new non-government organisation, crashing into the jungle like a young elephant, is bound to cause resentment, and perhaps bound to have unintended ripple effects. But without this elephant’s input of new money and ideas, the battle-front against malaria and other deadly diseases might present an even worse picture, especially if the field were left to governments and inter-governmental bodies.”

The President’s trip to Africa has put US HIV/AIDS assistance in the papers quite a bit. Last week the LA Times wrote this article praising the program and describing the experience before and after PEPFAR (the President’s Emergency Plan for AIDS Relief) in one Kenyan village. It’s a nice article, even if it is editorially inconsistent with the paper’s coverage of the Gates Foundation.

As this Op/Ed points out, the article failed to mention the many controversies surrounding PEPFAR. Those mentioned in the Op/Ed are that in the early years PEPFAR would only pay for brand name drugs, and that a signficant percentage of the prevention funds are still dedicated to abstinence programs. I’m personally not a fan of these requirements either. There are surely times to use abstinence messaging, or to at least delay sexual debut, but it would be preferable to let these decisions be made on a case by case basis.

I do sometimes wonder, however, how much of this controversy is just that a lot of people really don’t like the President or his faith-derived policies. If hypothetical President Gore had done the exact same thing, would people be this angry, or see it for what it is: a compromise to policy makers (and a lot of US voters) who are uncomfortable with HIV programming because they believe it implicitly accepts sex outside of marriage. Policies like the abstinence requirement got PEPFAR through a Repbulican administration and a Republican Congress.  There aren’t a lot of passing bills that don’t include some sort of compromise.

Frank Giustra, the mining executive who donated $131 million to the Clinton Foundation under shady circumstances, has issued a press release defending himself from what her sees as false reports. He addresses several factual errors, but doesn’t really provide any evidence to support the claims. As I see it, his arguments fit into two broad categories:

• Giustra is a rich, successful executive who was plenty rich before he met Clinton.  He know perfectly well how to negotiate a contract in a foreign country all by himself.
• None of the meetings reported in any newspaper ever actually happend.

With the presidential race still going on, no doubt this isn’t the last we’ve heard of this. I hope that somebody provides some evidence soon. Right now it is basically the New York Times’ word over Giustra’s.

Andrew Leonard, who blogs for Salon (free day pass required), commented yesterday on a new economics paper,  “Does Digital Divide or Provide?: The Impact of Cell Phones on Grain Markets in Niger”.  The article explains that increased access to cell phones in certain communities in Niger has had a powerful impact on grain prices. Giving people the ability to communicate over distance reduced regional grain price differences by 6.4%, and seasonal differences went down by 10%. The author estimates that the more regular prices meant lower costs for consumers during a period of shortages, and allowed people to buy from 8-12 days more food.

Based on this, Leonard then suggests that more Americans should donate their used cell phones for overseas use. He has a good point, and this is an example of a simple, painless kind of giving that can provide broad societal benefits.

I wonder how that would work. Mass donations from the US citizens require a high level of organization to collect, store, and distribute. It can actually be a very expensive process. It may turn out to be cheaper to market low-cost phones directly to poor countries. This is already happening, of course. There is also an apparently successful business model for selling refurbished cell phones.

As in most development effectiveness arguments, the answer is probably that both sales and donations are desirable. The sales reach a broader population, but the donations could be targeted a the people who are missed by the markets by poverty, location, gender, language, or one of the other countless variables that prevent people from fully taking part in society. Targeting these special cases would cost extra money, but would make the project fit much better into a comprehensive plan to increase cell phone use.