Group is likely to tie overseas aid to results
As many as 10 nations expected to lose funds
JOHANNESBURG -- For decades, one practice was widespread in the world of development aid: If a project in a poor country wasn't working, the solution was to throw more money at it -- and hope for the best.
Then many donors, most notably the Bush administration, began to insist on seeing proof that their money was well spent, with results that could be measured. But that new accountability was largely rhetorical -- until now.
One innovative group, the Global Alliance for Vaccines and Immunization, or GAVI, is expected at its board meeting next month in Geneva to withhold money to as many as 10 countries that haven't met performance goals. At the same time, GAVI, which has more than $1.2 billion to spend, probably will increase funds to as many as nine nations that have reported progress, GAVI officials told the Globe.
The money at stake in this round of grants isn't huge by international aid standards -- $6 million probably will be withheld from the underperformers and $3 million added to the bounty of the achievers. But a donor redirecting money is a bit of an earthquake in the development world. Some say the landscape of giving will never quite be the same.
"I can't think of any instances when the donor said, `You aren't getting any more money because you failed to get specific results,' " said Ruth Levine, an analyst at the Center for Global Development, a Washington, D.C., think tank that studies foreign aid. "The common response is almost the opposite: If something hasn't produced the results expected, usually the next round of funding can be larger."
Levine supports the idea of getting tougher. "There have been huge problems with donor credibility," she said. "Sometimes donors don't live up to rhetorical commitments to give money, and sometimes donors say they are going to cut off funds and they don't. GAVI could be different: It gives money in the amount promised, and at the same time it is willing to say no to countries that aren't performing."
Soon, saying no may not be so unusual. The Bush administration is establishing new funds, such as the poverty-fighting Millennium Challenge Account and a global AIDS initiative, that will be available only to countries that have proven histories of spending foreign aid wisely. But even those countries will be put on notice.
The Millennium Challenge Account will "demand accountability and results," Alan Larson, the State Department's undersecretary for economic, business, and agriculture affairs, told a House committee in June. "Each successful country proposal will include clear development objectives and benchmarks. Meeting these benchmarks will be key to continued funding."
GAVI was established four years ago to boost falling immunization coverage for children against a host of easily preventable diseases, including yellow fever, hepatitis B, diphtheria, and tetanus. It was meant to piggyback existing vaccination efforts and reward countries that had new ideas on how to immunize more children. The Bill & Melinda Gates Foundation gave $750 million toward the effort, while another $450 million has come from the governments of the United States, Britain, and the Netherlands, among others, as well as private contributors.
The organization has two funding principles. The first is to give money, with the expectation that the recipients produce results. Each country can determine, for example, whether the money goes toward buying a truck to transport the medicines or paying the salary of health care workers in remote villages. The second principle is that each country would have to vaccinate a predetermined number of children; if the nations fell short of that goal after three years, the money would stop.
On Dec. 2, the GAVI executive board will decide on funding for 19 countries. An independent board of experts, which met last week in Geneva, is expected to recommend that about half should receive the money and about half should not, GAVI officials said. Kenya and Madagascar are likely to lose funds, GAVI officials said. The recipients should include Uganda, Mali, and Sierra Leone, which had a low base of immunization coverage because of the longtime civil war and has been able to successfully build on that in the last two years.
Kenya is poised to lose $1.9 million, which accounts for less than 5 percent of its immunization budget. Uganda, though, could receive $4 million, or more than double the money originally set aside for that nation.
The possible loss of funds is upsetting to Nairobi. In May, Health Minister Charity Kaluki Ngilu learned that the 2004 money was in jeopardy, and she made an impassioned plea to GAVI officials in Geneva to give the country more time. She said the new government, which came into power late last year, had to rebuild health systems that crumbled during nearly a quarter-century of corrupt autocracy.
"We are just putting our act together as a government. We are now putting the health infrastructure in place," said Gideon Konchella, assistant health minister, during a recent interview in Nairobi. "Cutting funds for whatever reason will hurt poor people who depend on our support."
In the early 1990s, Kenya said it immunized three of every four children against six major vaccine-preventable diseases; by 2001, the rate had fallen to 46 percent, or 825,000 children. GAVI and Kenya agreed to a goal of immunizing 954,000 children by 2002, but the government said it reached 775,000. And a team of outside auditors said it didn't believe Kenya's numbers.
"It will be important now to see how those countries that are lagging behind will respond to this," Tore Godal, GAVI's executive secretary, said in a telephone interview from Geneva. "How will they try to improve their performance so that they can again receive our money?"
Godal, who has worked in global health for three decades, noted that GAVI's efforts have led to the immunization of about 8 million children. "I have never before experienced such a rapid scale-up of a new program," he said.
He said GAVI's system of giving countries leeway on how to spend the funding but also putting pressure on succeeding has "stimulated them not to look at the donors and see how the donors want to use the money. Instead, they can now look at their own problems and then have the freedom to target critical bottlenecks."
John Donnelly can be reached at donnelly@globe.com.
