Earlier this month, the Harvard Initiative for Global Health hosted Dr. Dambisa Moyo, author of the newly released and highly controversial book, Dead aid: why aid is not working and how there is a better way for Africa. Moyo’s thesis is that development aid has harmed rather than helped Africa, in particular by reducing the accountability of governments and eliminating the incentives to stimulate economic growth. The book, drawing heavily on economic indicators and analysis, reflects Moyo’s background: her professional experience includes time at Goldman Sachs and the World Bank. She posits that all aid, excepting charity and emergency response, be phased out of Africa in the next ten years. Instead, countries should follow China’s example and approach African countries as business partners or investments.

During her presentation at HIGH, Moyo stated up front that many of her ideas were not novel: for those working in the development field, much of her book would be familiar. The government of Rwanda, in its Vision 2020 plan (PDF) for economic growth released in 2000, includes eliminating dependence on aid as one of its main goals. President Paul Kagame, a figure referenced by Moyo repeatedly, publicly denounces dependence on aid, though it currently comprises about half of the government’s budget. More recently, sentiments similar to Moyo’s were expressed in William Easterly’s book, The white man’s burden: why the West’s efforts to aid the rest have done so much ill and so little good, published in 2006.

Moyo explained that her goal in writing Dead Aid was to move the conversations that take place “behind closed doors” out in the open and engage the general public more vigorously. Given that the book in many ways captures opinions that are widely held in the field, it is perhaps her conclusions that have drawn the most visceral criticisms from the field. Michael Gerson, in a Washington Post review wrote, “the book is something of a marvel: Seldom have so many sound economic arguments been employed to justify such disastrously wrongheaded conclusions.” Kileken ole-MoiYoi, a GHD case writer, wrote a response in the Foreign Policy Digest as well, with more nuanced critiques of Moyo’s recommendations. Our MIT colleagues also shared links to interesting interviews of Moyo and additional book reviews on their blog.

While aid efforts are often criticized, for practitioners working in the context of HIV/AIDS, the state of antiretroviral therapy (ART) access in Africa can no doubt be credited significantly to the creation of President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Malaria, and Tuberculosis. By 2007, about three million Africans were receiving ART, a 7.5-fold increase from 2002. Dr. Paul Collier, a former advisor of Moyo, notes that the research data necessary to evaluate Moyo’s claim is “shambolic”.  Rigorous assessment of outcomes, operations, and systems at the country or cross-country level must be conducted in order for these dialogs to move towards evidence-based policy recommendations. Currently, GHD is leading the international academic consortium of the World Health Organization Maximizing Positive Synergies Research Project called “Maximizing positive synergies between health systems and Global Health Initiatives,” investigating questions that are highly relevant to this discussion: how have GHIs impacted health systems? And more specifically, what factors contributed to the successes and failures of GHI investments to have large and positive effects on the health system?

To research the second question with the necessary depth, GHD is developing three country-level case studies, which involved significant interviews with government officials, donors, implementers, and others in the focus countries of Kenya, Haiti, and Rwanda. Combining this methodology with a macro-level cross-country analysis and program-level data will produce, to our knowledge, the most comprehensive research effort on these questions to date. It will also provide new evidence that may generate dialog on how to redesign efforts to reach optimum health outcomes in resource poor settings. These cases, which will be added to a library with cases written by other academic partners, will help inform a report to be presented by the WHO at the upcoming July G8 meeting. They will be made available in the fall, so check back to the GHD blog for more announcements if you’re interested in reading more.