What’s needed in 2024, and more importantly, who should decide what’s needed.
I face a dilemma: half of the colleagues I work with and admire are calling for an end to aid dependency, and the other half are calling for increases in development aid (ODA). Are these two positions compatible, and what should we – as global health advocates in the Global North – do about this dilemma?
For most of my career, I have been working together with colleagues in the Global North calling for increases in ODA. Countries in the Global North have for decades committed, recommitted, and slid beyond and more often far behind the 0.7% GNI ODA target (and the 2001 Commission on Health targets for health ODA). Over the past 15 years, these targets have been complemented by domestic financing goals, with the Abuja targets for health by African countries the most known. Increases to ODA have been framed as a moral and charity issue, a rights and justice issue, or (by IFIs) as an economic growth issue. To paraphrase all rallying calls: “Aid is the right thing to do, and the economically smart thing to do.”
In 2010, then working for one of the large IFIs, I read William Easterly’s The White Man’s Burden and Dambisa Moyo’s Dead Aid. More than a decade later, fuelled by the inequities of the global COVID-19 pandemic and a debt crisis caused in part by development loans and dependency, calls for decolonizing aid and global health have resurfaced. The broader movement criticizing our current ODA and aid models has framed their criticism around power imbalances, colonialism and outright racism, and economic dependency. In a paraphrased nutshell: “It’s not aiding, it’s harming the Global South.”
A few weeks ago, I watched a hybrid talk by Ṣẹ̀yẹ Abímbọ́lá on “Unfair knowledge practices in global health”. Presenting six “articulations” of how such unfair knowledge practice manifests itself, Sèye spoke about positionality as well as connections. Many reflections from the talk (including the white gaze, quoted in the slide above) resonated with what I have seen working in the sector these past 20 years – especially in moments when I have felt a strong discomfort. I have written about some of these discomforts (or should I call them disgust?): arrogance, racism, exercise of raw power, self-interest…
Yet I admit that I am drawn to the moral argument (and even at times the economic case) for development aid. To be frank: I still believe in ODA. There are, I and many others believe, always going to be pockets of populations and people who are deprived of access to affordable services or products because of where they are (e.g., in a conflict zone or in a failed state) or because of who they are (e.g., a discriminated population group). If a state fails in its responsibility to provide, then others should jump in, in my opinion. This is why I continue to donate to certain charities and NGOs.
What I increasingly believe and have seen, though, is that there is a massive risk of mission creep (“let’s just provide more, and actually everything, always…”) and arrogance that goes together with growth (“we’ve bought and built all of this expertise, we know what you need, how, and when…”). In my experience, ODA and its various mechanisms (including Global North Ministries) are often too distant, too arrogant, and often driven by self-interested motives, to care about what people in the Global South really need, not to mention disinterested in asking or listening. Even when people or countries are invited “to the table”, I’ve seen how they have been engaged symbolically, if even that. That “white gaze” is very real, and very strong.
I feel this dilemma very strongly in my advocacy and work. I’m not quite ready to take “one side”, and maybe never will. What worries me are two things: the two current communities I engage with (pro-ODA and anti-ODA) are not engaging with each other. There’s little debate, in part because there’s little support of funders to support (or allow for, in the case of pro-ODA) such debates. Our advocacy is polarised and fragmented, in part because of advocacy funding models.
Ultimately, there’s one thing I’m certain of after all these years: IF we engage in and finance ODA from the Global North, we have to listen to what people and countries say they need, and how they need it. It’s embarrassing, to the point of extremely distressing, to listen to proponents of ODA claim they “know what’s needed” (and then present a package of products to go with it). If this is what’s meant by defending ODA, not in my name, not with my voice, and to quote James Baldwin again from the slide above “not with the ‘little white man that sits on your shoulder'”.
Katri Bertram 