A (3:20)

You've given people a sneak peek at some of the results in a blog that I think went up today. And you've got a chart in which it shows the share of respondents, I believe, in Africa who think that health and education are priorities. It's in the single digits.

B (3:34)

Yeah, it's in the low single digits. And it's been in the low single digits ever since these public attitude surveys. In this case, the group that does them is called Afrobarometer. They've been doing this since the late 90s. It's always been low, which does make you scratch your head a little bit. This is before the global response and domestic response to the horrible AIDS epidemic. Height of the AIDS epidemic and people were still saying only 5, 6% of them in Africa were saying health is the biggest national problem that we all need to focus on. It's always been low. It's always been jobs in the economy. Inequality, infrastructure has doubled over time. It used to be as a concern, as a concern. In the early 2000s, one in 10 Africans said infrastructure was the most pressing national problem. Today it's 20%, 1 in 5.

A (4:30)

So I don't know. This raises a whole bunch of questions. One doesn't really have to do with donor alignment is what's wrong with those people in Africa? Don't they know that they're sick and illiterate? I mean, excuse me, I'm paraphrasing here, but from the outside perspective, you would think, you know, if you've got these problems which we in the west constantly hear about, why aren't those concerns reflected in Africa Barometer in a higher level? And obviously that reflects something about my perceptions of Africa. You know, maybe it's not as bad as I think.

B (5:00)

Yeah, it's. It's a great question. It's a hard question to answer, to be honest. Here's my working thesis, though, is if you look at the issues that consistently are at the top, jobs, economy, infrastructure, I would sum those up as access to opportunities so people have the opportunity to earn more money to access services. So if they are geographically isolated because of a lack of roads or something along those lines, that if they have better opportunity then they would be able to address things like paying for health clinic visits, paying for school uniforms. It basically is the lift yourself up by your bootstraps mentality of if you got more money in your pocket. Everything else is that much of, you know, those concerns are more addressable.

A (5:54)

And why haven't and I think you focused on US Foreign assistance, but I suspect it's probably would be true of other donors, but just confined to the US Why doesn't US Assistance align better with what people in Africa and Latin America say they want?

B (6:10)

Yeah, it's one of those ones where it's very complex, which is difficult for an interview like this. But let me cite off a couple of things on why. I think what we find first is domestic political considerations and constituencies. So there are very forceful and effective advocacy organizations and movements for health funding, for education assistance, some of the softer stuff that connects with ordinary Americans as well as politicians as well. So I don't think it's a surprise that you see significantly more funding for that than you do for jobs and infrastructure. And when I've talked to congressional staffers or other people in the past about these issues, one of their responses is how do I sell jobs and infrastructure when America's infrastructure is crumbling and when Americans are out of work so it becomes more difficult to communicate. I think that's one. Secondly is US Development organizations and programs have been built up over time. So there's a huge infrastructure, so there's a political infrastructure in constituencies, but there's also a bureaucratic infrastructure where the contractors and the field staff and all those things. It's a very large beast now and it takes on a life of its own. You don't just automatically cut all of that to shift priorities, new priorities or existing priorities that have been under, underserviced. So that those are just two. I think there's a couple of other reasons, but I think those are probably the biggest two.

A (7:59)

Well, and I imagine those are, you know, they're tangled in together. If I am motivated by altruistic concern about health and I get my master's in public health and I subsequently go and work in Africa, I see that there's a need there. I see that I'm doing good work. I come back, I have an opportun to speak to my congressman. Is it because I want to make work for myself? Maybe. Is it because I think we're doing good work? Probably that too. So this, this combination of sort of self Interest and altruism plays into that story, I imagine, in a way that's very difficult to then shift to something else.

B (8:33)

Yeah, absolutely. And that actually is a great trigger for a third reason, which I think is very, very relevant for health programs. Over time there's been a greater orientation towards assistance that is pretty straightforward in terms of delivery. So inputs leading to outcomes, you find that in the health sector. So we buy vaccines, we administer vaccines, we save lives, we buy antiretroviral drugs to combat AIDS and keep people alive, we deliver those. And it has an impact in other areas like jobs. It's much more complicated. And it's not input, outcome, it's how do your inputs flow into policy change which impacts the overall operating environment and then leads to jobs. So when there's greater public scrutiny, congressional scrutiny for results, results and results, it leads towards a skewed focus on these kinds of programs. They are saving lives, they're doing immense good. So the research that I do is not suggesting that we shouldn't do those kinds of programs. It's a bigger question of are we aligning in a grander sense with what people care the most about? So it doesn't necessarily have to be zero sum.

A (10:01)

Well, and I was thinking that work here at the center has both reflected and I think contribute to that sense, that consensus that especially in the health sector, it's an area where outside assistance can make a huge difference. And I'm thinking here of Ruth Levine's book, Million Saved and Proven Successes in Global Health, in which there were 17 case studies. That's probably one of our very best selling books. It's used widely in college courses. It was possible for Ruth and her team to document these large scale, sustained successes with outside assistance and even aid. Skeptics then, like Bill Easterly, when they are criticizing aid, will sort of make an exception and say, well, we do know it's worked in the health sector. So that maybe brings me to my next question, which is, you know, we have in our own center here people like Arvind Subramanian who say bollocks it all. You know, aid is not only not effective, it's not helpful because it undermines societies seeking their own solution. We shouldn't spend time talking about aid effectiveness. We don't really know what works. We don't know how to change societies. We should focus on things like trade and intellectual property rights and reducing our own emissions. In terms of climate change and the whole non aid development policies, if we don't know how aid works, we're not confident there's not a consensus in the development community that it's even a good thing. Maybe it's just as well that it's ghettoed into health and education where it can do less harm.

B (11:35)

Well, that's a pretty bold, bold, bold perspective.

A (11:38)

First, do no harm, keep it in health ghetto.

B (11:43)

I would not necessarily ascribe to that. I think there are some important areas where aid and aid like assistance. So I should actually pause for a moment and say in this paper I look at both official assistants, but I also look at things like the Overseas Private Investment Corporation, so broader development financing in Africa, in Latin America, so these kind of quasi aid instruments are also included and we still find really low alignment. But I think there are a number of different examples where an organization like opic, Overseas Private Investment Corporation, has pursued very targeted transactions or programs and it's led to job creation and it's led to improvements in the overall business environment. Like in Togo, opic, with partnering with a US Company, went in and built a power plant and it got rid of the rolling blackouts. It dropped costs for businesses there and also increased access to households. So it removed a major barrier to business opportunities and economic opportunities. So there's examples like that.

A (13:05)

So if we were doing more in these areas that address jobs and infrastructure in Latin America, crime, we might learn more and have some more successes. As it is, we're not spending very much more on it. I want to take a break here because you do have, I think, six very concise policy recommendations. We're starting to slip into that. What does it mean for what we would do differently? When we come back after the break, I'm going to ask you to walk us through those. This is the Global Prosperity Wonkast from the center for Global development, I'm Lawrence MacDonald. My guest today is Ben Leo. We're talking about how well U.S. foreign assistance aligns or does not align with the concerns of the people that it seeks to benefit, particularly in Africa and Latin America. Will be back in a moment. Welcome back to the Global Prosperity Wonk cast. I'm Lawrence MacDonald. With me in the studio today is Ben Leo. He is the director of center for Global Development's Rethinking US Development Policy Program. And today we're talking about a forthcoming paper in which Ben compares the allocation of U.S. foreign assistance with what people say and have said consistently in public opinion surveys are their priorities. Ben, you say in the paper you did this for Africa and Latin America. You didn't do it for other parts of the world because we Just don't have the surveys. Those kind of surprised me.

B (14:52)

Yeah, I wish we did have coverage in other regions, particularly East Asia, South Asia, and we just don't have the information. I hope that gets addressed at some point and that becomes available.

A (15:04)

I'm guessing though, that the bulk of US Foreign assistance, in fact, is going to Africa. When you look at development system, is that the case?

B (15:11)

It accounts for a big percentage, although you have the frontline states issue with Afghanistan, Pakistan in the past, Iraq.

A (15:18)

Setting aside the war zones, setting aside.

B (15:20)

The war zones of the top national security countries, a big chunk goes to sub Saharan Africa.

A (15:27)

So in the first part of the show, you explained how you've looked at these public opinion surveys pretty consistently. People in Africa are concerned about jobs and infrastructure and Latin America, it's jobs and infrastructure and crime an additional concern. And U.S. foreign assistance tends to be focused on other areas, primarily health and education. There's an argument that, well, maybe donors should do what they know how to do. You started to explain that we actually have some successes in other areas. But in the paper you've got six recommendations and I want you to just walk us through them quickly. Your first is require regular citizen surveys to help formulate foreign assistance strategies. Would that work? You explained that there's all this politics and bureaucracy that's driving U.S. foreign assistance. The surveys are out there. Right? All they need to do is read your paper. And if they were interested in aligning U.S. foreign assistance with what people want, you wouldn't need to do more surveys.

B (16:25)

I would love for it to be that straightforward. It's going to stay messy. But right now, when people are making budget decisions either in the executive branch or on the Hill, they're not looking at this information. I was actually just talking with somebody a few nights ago over dinner who was the lead staffer for Appropriations for a decade, and I asked him, have you ever seen this before? And he said, I have never seen anything like that and I've never heard it mentioned. So having at least the information about what people say in the hands of decision makers is a good thing.

A (17:01)

And they're more likely to pay attention if they commission the survey than if somebody sends them the Afro barometer.

B (17:07)

Well, here's the interesting thing. The US Government already is commissioning Afro barometer. USAID pays for it, but it's not being fed into US Government decisions. So. But if they don't like Afrobrometer, they want a tailored survey. Great. Have a new survey.

A (17:24)

So when you say commission surveys, really what you're saying is feed this into the discussion. Discussion, it's got to be present in some way. Even if you later decide, hey, what we care about is aids, we're going to fund aids. At least you've had the discussion that what Africans would like you to fund is infrastructure and job creation.

B (17:39)

Exactly.

A (17:40)

Your second one leads to the question about or is related to this focus of US assistance on HIV AIDS recalibrate health assistance programs in Africa, what does that mean?

B (17:51)

So if the US government is going to put its money where its mouth is, so the US officials for years have been saying we care about country led development, we care about aligning our money with their priorities. So if the US government is going to put the money where the mouth is, then in Africa it is impossible without having a thoughtful look at health. Health is the lion's share of US spending in sub Saharan Africa and as we talked about before, it doesn't poll that high. It is a top three, top five concern in a handful of countries, but not in most. So when you have a lower tier priority like health accounting for the bulk of spending, you're going to have to address it. Now there's a bigger dynamic in the health space right now where, particularly for HIV aids, for the sustainability of the effort, African governments are going to have to take on more of the responsibilities themselves to cover treatment costs and things like that. We're seeing this already happen in places like South Africa and Rwanda. We know that PEPFAR and the US government want to continue this trend. It's got to be accelerated, otherwise we're just not going to be able to do.

A (19:12)

When you say recalibrate, what you mean is gradually withdraw some money from the HIV AIDS effort and encourage African governments to take it on themselves.

B (19:24)

Yeah, I think it's a transition. Yes, it's a transition for the governments assuming more and more responsibility for treatment, care, etc.

A (19:33)

Individual costs have come down. African economies are growing better. They now have a constituency of people on these drugs that if they withdraw the drugs, the governments themselves are going to have some trouble. So perhaps it's something where there's a mix of factors in play that could cause the governments to step forward and begin to fund more of this.

B (19:50)

Absolutely. It's not going to be possible in all countries, but there are a lot of African countries where the resources are much more available than they have been in the past because growth has been so large over a sustained period of time. Now I should say though, if there is going to be recalibration of health spending in Africa, it has to be Extremely thoughtful and careful so that the gains of recent years are not erased.

A (20:17)

And if you were able to do that, presumably that could, at least in theory, release some resources for other things. Which brings me to number three, increased support for the African Development Bank. And I saw in the paper that you said that the African Development bank, which by the way as you note is majority controlled by the countries in Africa is much better aligned in its spending.

B (20:38)

It absolutely is. So I do a head to head between the African Bank, African Development bank and the us US for all the countries, African countries with surveys. And the African Development bank does significantly better in terms of aligning its money in all but four countries. So it is very focused on Africans priorities, infrastructure, jobs, these other things.

A (21:03)

And here I'm reminded of the report done by Todd Moss and a working group that you probably were part of on the African Development Bank. And one of the top line things was choose a sector, focus on it. A good one might be infrastructure, which I think wasn't new with cgd. It reflected thinking going on in the community. But it sounds as if the bank has really gone laser like after infrastructure, which responds to what Africans want.

B (21:29)

Absolutely. It's Africa's bank focusing on African priorities.

A (21:33)

Number four, expand underutilized private sector based development tools such as. And those who know Ben and Todd and others around here will have no problem completing that sentence. The Overseas Private Investment Corp. Do we love opic?

B (21:50)

We don't love OPIC enough. We don't love OPIC enough. And when we're talking about money in a tight budgetary environment, OPIC is a fantastic tool. Not only does it not cost taxpayers anything, it actually reduces the deficit when profits go back into the U.S. treasury. OPIC is sitting on 12, $13 billion of deployable capital that it can't move because it doesn't have enough staff to actually look at project proposals. So if it got more staff, it could significantly increase its investments and it leverages so it crowds in private capital. So what you're really talking about is 35 to $40 billion of capital that's sitting on the sidelines right now that would go for things like jobs, infrastructure and what ordinary people care the most about. So if you want to do alignment, you want to do smart development and you want to reduce the budget deficit.

A (22:48)

Go opic, you got me. I'm in favor of it. I don't know why it doesn't happen, but we'll keep talking about that and see if we can make a change there. 5. Increase its engagement in Latin American Countries to help combat crime and insecurity. That sounds to me like a minefield, boy. I think of the US involvement in security and the training of police forces that turned into death squads. And how do you do that?

B (23:14)

Well, yeah, I'm going to tread lightly on this one and I'm going to rely on what the data is saying in terms of where the best programs are and things like that. So crime and security is the number one concern across all of Latin America now. It overtook jobs and income opportunities during the last survey. And what I find is in a number of countries, the US actually is spending a lot of money to help address crime issues. But there's some other countries where it's not. Take Honduras.

A (23:45)

The alignment is good in Colombia, right?

B (23:47)

The alignment is good in Colombia and Mexico and some of these countries where there might be. Yeah, war on drugs. There might be some controversial perspectives in terms of whether that money is best spent or if there's costs that go along with it. But there's no question that the ordinary people in those countries really are concerned with crime and security. Take Honduras. We just had an election and jobs and crime were at the very top of the list. And I was just looking at the US assistance figures for Honduras right before we started this interview. And lo and behold, last year the US spent essentially no money on crime and security issues in Honduras, even though it's at the top of the list. So one of the recommendations is US Government officials, decision makers should have a hard look at where there are gaps, where the people say crime is a very big concern and we're not doing much to help them address it.

A (24:50)

This brings us to better leverage the Millennium Challenge Corporation, which is the only US development institution with an explicit mandate to support country based priorities. That raises a question. Is the MCC's allocation better in line with country priorities than US foreign assistance overall?

B (25:09)

Absolutely. Absolutely. So there is definitely an MCC effect that I find in, in terms of alignment. So where the U.S. particularly in Africa, where the U.S. has addressed local concerns in a more forceful way, almost always it's because of the mcc. The MCC focused on infrastructure and jobs and when the US has not had the MCC engaged, alignment is significantly lower. So there is a, a very strong case for the MCC's country led approach. When it comes to alignment. It outperforms.

A (25:49)

We're just about out of time. Ben, I have a parting thought and then I want to ask you if you've got one. My parting thought is whether you are an aid aficionado or not, read this paper. It is terrifically put together, very clearly argued and filled with, I think, very interesting charts that show this misalignment one from the other. We'll be releasing it on December 3, about the time the Wonk cast is posted. It'll be online at CGD and I think it'll make great holiday reading if you got nothing else to do. Ben, closing thought.

B (26:23)

Yeah, I should say that this has been a really fun, interesting project to work on and as people do read it, I hope that they come into it with an open mind and not think, well, this is how it has to be because it's always been this way. I think it raises a number of really big strategic questions from a development perspective, from a foreign policy perspective and a national security perspective that I'm quite surprised has not permeated the community in this town in a more pronounced way. So if this paper helps to to advance the discussions that aren't or start the discussions that should be already taking place, then I will consider it a success and I'm going to be doing additional work on it in the future. So as people hear this Wonkast as they read the paper, I hope that they will shoot me reactions and ideas because this isn't the end of the road.

A (27:22)

I said I had a party thought, but I have another thought too, just in closing and that is this is the kind of work, and I notice it's not only here at cgd, obviously it's in lots of places, but it's the kind of work that I really admire where you take something that is fairly basic. The data is out there in this case and it's done. Obviously, technically it's superbly done in comparing everything, but the basic intuition is kind of like, well, duh, it would make sense to look at aid allocation and what people say they want and once you hear it, you can't forget it. I guess it's maybe that quality of why didn't I think of that, right? Not me, but why didn't somebody else think of that? It has this sort of simplicity about it, combined with the sophisticated instrumentation looking at everything that I just think is terrific.

B (28:14)

Well, I'm glad you enjoyed it, Lawrence.

A (28:16)

This has been the Global Prosperity Wonkcast from the center for Global Development. My guest today is Ben Leo and we've been talking about his forthcoming paper, Is Anyone listening? Does U.S. foreign assistance target People's Top Priorities? Spoiler here generally not very well. You can find the Wonkast online on itunes and on stitcher. Just search for wonkcast or CGD and sign up to hear a new interview every week. Until next time, I'm Lawrence MacDonald. Thanks for listening, Sam.