Friday, June 12, 2009

The Myth of NGO Superiority

The Myth of NGO Superiority
Peter Nunnenkamp

It is easy to lament the stinginess and selfishness of official donors, as Kishore Mahbubani did in 2008. Those donors provide critics with the data needed to expose the flaws of official development assistance (ODA). It is different with NGOs. Their aid is certainly relevant, but its allocation has hardly been mapped, let alone explained. The main reason is that sufficiently detailed data are hard to come by. After all, NGOs probably do not want critical analysis to tarnish their image of being superior donors.
NGOs are often believed to provide well-targeted aid. They are said to be particularly close to the poor, as many of them directly cooperate with local target groups, circumventing recipient governments with a reputation of corruption. Accordingly, the argument goes, they are better aligned to poor people’s needs, and suffer from less leakage. Moreover, it is said that NGO aid is less distorted by donor governments’ commercial and political interests, such as export promotion or political alliances.
Donor governments seem to share that favourable view. To a large extent, they channel ODA through NGOs. In some donor countries, the share of such ODA is as high as 20 %. The total of aid granted by NGOs from OECD nations amounted to almost $ 15 billion per annum in 2005 and 2006. That sum exceeded bilateral ODA from every individual donor country except for the USA.
Some critics, however, suspect that the case for NGO aid largely rests on ideological grounds. The view that NGOs have a clear focus on the poor first came under attack in the 1990s. Critics believe that NGOs probably prefer the quiet life of implementing their national governments’ agendas to risking failure in attempts to outperform state agencies. This seems all the more likely as some NGOs financially depend on official “backdonors”.
The cases of Sweden and Switzerland
uch criticism is hardly supported by empirical research so far; and that is something it has in common with the wide-spread faith in high NGO performance. NGOs only rarely support scholars who collect data. Doing research on German NGOs, for instance, therefore tends to be frustrating. By contrast, two relatively small donors – Sweden and Switzerland – offer reasonable data to compare NGOs and state agencies by analysing the following three questions:
· Do NGOs focus more strongly than ODA on those countries where need is most pressing?
· Do NGOs engage in particular where the policy environment is difficult, so government-to-government transfers are unlikely to work?
· Do NGOs behave more altruistically than state aid agencies, which may be pursuing hidden agendas?
Research done at the Kiel Institute for the World Economy in cooperation with the KOF Swiss Economic Institute in Zurich and the Radboud University in ¬Nijmegen has led to only preliminary results so far, but they do reinforce the sceptics’ view on NGO aid. The answer to the first question is clearly “no” if one judges recipients’ need for aid by average per-capita incomes. The increase in Swiss NGO aid for countries with lower average income, for instance, was slightly less pronounced than the increase in Swiss ODA. In striking contrast to Swedish ODA, Swedish NGOs completely ignored the income position of recipients, spreading their aid almost equally over low and middle-income countries. The poorest 25 % only received 27 % of Swedish NGO funds, whereas the wealthiest 25 % received 22 %. The picture is more favourable for Swiss NGOs if need is measured in terms of absolute poverty (share of the population living on less than one or two dollars per day). Swedish NGOs hardly differ from state agencies in this respect.
As for institutional environments, we found interesting differences between Sweden and Switzerland, but they did not follow the NGO-government divide. Both Swedish and Swiss NGOs tended to mirror their governments. This is in conflict with advice by the World Bank which is echoed in many policy documents both at UN and national levels. Accordingly, official donors should focus on better governed countries in order to render ODA more effective, whereas NGOs should become active predominantly where governance is bad. Just like the state-run agencies, Swedish NGOs were not particularly active in challenging settings. Swiss NGOs did allocate more funds to countries with weak institutions – but so did the Swiss government. It thus seems that Swiss NGOs were accommodating government policy rather than trying to excel in places where governance was particularly troubled.
As for donor countries’ own interests, neither Swedish nor Swiss NGOs seemed to be pursuing any hidden agenda. The notable exception was that Swiss NGOs resembled their government in providing more aid to countries that voted in line with Switzerland at the UN. Switzerland’s neutrality may be at the root of this finding; both the government and NGOs may feel that developing countries that take a similar stance deserve support. On the other hand, countries with commercial relevance to both Sweden and Switzerland, for instance as export markets, did not get significantly more NGO aid. Once again, however, NGO performance did not differ much from their governments’. Comparisons among OECD countries typically show that Sweden and Switzerland belong in the “altruistic” camp of countries that do not use ODA to promote exports.
NGOs based in various OECD countries
NGOs may have better chances to excel in less altruistic donor countries. OECD nations that are known for more self-searching development policies include big donors like France, the USA and Japan. To assess NGO aid tentatively for a broader donor sample, our Dutch co-author, Dirk-Jan Koch, collected data on some 60 OECD-based NGOs. Together, these NGOs spent $ 5.7 billion on aid to almost all recipient countries in 2005. That was nearly as much as the four Scandinavian countries spent on ODA that year.
One may, of course, doubt the representativeness of the sample. Moreover, the data only refer to one year. Nonetheless, it is striking that the aid allocation of the seven German NGOs included in the sample was actually biased against poorer countries. Brazil and South Africa were among the top-10 recipients of German NGO aid in absolute terms, even though the per-capita income of both countries ranged in the highest quartile. The top-10 with respect to aid per capita included four countries in the upper income half (Botswana, Cape Verde, Namibia and Swaziland). The whole group of 60 NGOs granted more aid to needier countries, however.
The impact of local institutions on NGO aid from all OECD countries together remained inconclusive. It seems that many NGOs were torn between favouring better governed countries and allocating aid in accordance with the comparative advantage NGOs might have in working under difficult local conditions. NGOs from all donor countries taken together have a strong tendency to replicate the aid allocation of official backdonors. This indicates the limits to autonomous decision-making of NGOs that depend on government funds. Moreover, NGOs tend to follow their peers, probably in order to control risks by hiding in the crowd. In any case, NGO aid is clustered, and NGOs are deepening the divide between so-called donor darlings and aid orphans.
Conclusion
All in all, our findings point to NGO aid not being a panacea for providing better-targeted aid and boosting aid effectiveness. In contrast to what one might expect, NGOs seem to prefer to keep a low profile. They did not try to distinguish themselves from state aid agencies by outperforming the latter in terms of focus on the neediest, or by entering uncharted waters where ODA is likely to fail.
The preliminary nature of the findings reported in this short account of ongoing research must be stressed. Future research will have to look into what exactly is driving NGOs to replicate both official donors and peers. It must also be understood to what extent NGOs that rely strongly on official backdonors behave differently from those that are truly independent. To assess these matters, it would certainly help if NGOs became more transparent and opened their books to research.
Sources:
Dreher, Axel, Florian Mölders, Peter Nunnenkamp, 2007: Are NGOs the better donors? A case study of aid allocation for Sweden. Kiel Institute for the World Economy, Working Paper 1383, October.
Koch, Dirk-Jan, Axel Dreher, Peter Nunnenkamp, Rainer Thiele, 2008: Keeping a low profile: What determines the allocation of aid by nongovernmental organizations? Kiel Institute for the World Economy, Working Paper 1406, March.
Nunnenkamp, Peter, Janina Weingarth, Johannes Weisser, 2008: Is NGO aid not so different after all? Comparing the allocation of Swiss aid by private and official donors. Kiel Institute for the World Economy, Working Paper 1405, March.
Peter Nunnenkamp heads the research area “Global division of labour” at the Kiel Institute for the World Economy. The research that lead to this essay was done in cooperation with the KOF Swiss Economic Institute in Zurich and the Radboud University in Nijmegen.

Monga, Micro credit And The Nobel Prize


Monga, Micro credit And The Nobel Prize
By Anu Muhammad
04 December, 2006
www.Countercurrents.org

'We link the poor to the market...'

NGO official in Bangladesh

"When I feed the poor they called me a saint but when I asked, 'why are they poor?' they called me a communist."

Archbishop Helder Camara in Brazil

Every year we have monga in Bangladesh. Monga is a local Bangla word that means a famine like situation, which appears specially in September through November or in Bangla months Aswin and Kartic. People usually call the period as mora Kartic, meaning the months of death and disaster. These two months give rural people more hard time than usual because of extremely shrinking job opportunities. A large number of rural poor try to survive by migrating into towns, in addition to those who migrate for good. Not everyone can do it. There are many who are pushed to worse situation, compelled to eat not-eatable things and get sick, if not worse.

This year is not an exception. However, one thing is very special in this year. Dr. Muhammad Yunus and the Grameen Bank have achieved the highest award, the Nobel Peace Prize, for their contribution in poverty alleviation. According to the Nobel Committee, the model of 'Micro-credit has proved to be an important liberating force' meaning instrumental in poverty alleviation. Despite whole Bangladesh, specially the urban middle class and upper income people, overwhelmed with joy and pride, the reports on monga found its way, got comparatively shorter space this year, to create an embarrassment to the mood. In fact, it is not only in the monga period that people suffer from hunger. Despite self-sufficiency in food production in the country, majority people, over the year, suffer from food intake that goes below the poverty line calorie level, half of them live in hardcore poverty meaning they live with regular hunger. A monga situation is a permanent experience for them.

What macro data speak about poverty in Bangladesh after decades of innovative and successful poverty alleviation programmes in Bangladesh? The latest figure on poverty delivered by research organization Bangladesh Institute of Development Studies showed in recent overview (October 2006) that nearly 40 million people in Bangladesh are living in extreme income poverty and about 30 million are in chronic poverty. According to the government document, nearly 70 million people are still living below the income poverty line.

In this poverty friendly scenario, the two months become so severe that it is difficult to hide the wound as well as the vulgarity of never ending poverty alleviation programmes, studies and festivity. Monga sustains and are renewed every year. Therefore, it is necessary to look at coexistence of sustained monga situation and huge success of micro credit in perspective.

The mobility of Global Capital

Dr. Muhammad Yunus became world famous personality along with the Grameen Bank much before the Nobel recognition. The world gurus have been talking about the Bank as a model to alleviate poverty for years, and its success is also measured by its spread in many more countries. Establishment of an institution like Grameen Bank with own initiative and develop it into a global level is really a great achievement of Muhammad Yunus and others in the Bank. Moreover, Yunus and his colleagues have helped micro credit to integrate into mainstream banking operations. That is obviously a brilliant achievement for him and this is also very crucial contribution of him to the 'late capitalism' of the present world.

In the present phase of global capitalism financial sector has become dominant over production sectors. Investment in speculation multiplied much faster than investment in other sectors. Banks, Insurances, share markets, all have become much more crucial. Financial capital, as a whole, has taken the lead of global capitalism. The unprecedented growth of 'money for money' activities helped many rich to become richer at a rate that is unprecedented in history. These may not bring good moment for the majority. Because, these activities have fraudulent elements and often create disastrous affects for many. Some of it became visible in the recent past in many countries including Argentina and many countries in East Asia. Other countries including the US had the heat of it. The force of uncertainty and collapsing experiences prompted James Tobin, leading economist of the US, to ask for imposing taxes on this speculative investments and transfer of money. George Soros, the guru of speculation and financial investments cautioned global leadership to take actions, extend state control over uncontrolled money movement, to save capitalism.

Capitalism in its stunning horizontal and vertical growth, borrowing Marx's words, revolutionized everything, touched everything, moulded everything and spread fast to become a global system. Now we are witnessing a real global capitalism. Nevertheless, despite its success in revolutionizing many things and radically opening up global opportunities for capital, capitalism could not resolve its inherent dynamics that creates contradictions in itself. Therefore, development and destruction go hand in hand, with growing resources and increased deprivation, with increasing potential and increased vulnerability of the people, increasing command over knowledge and horrible level of mass destruction. Therefore, the world with unprecedented growth of resources witnesses high level of poverty and insecurity. Uneven development in global scale as well as within country is an integral part of that. Bangladesh, located in the periphery, has been a victim of both.

In the last few decades, finance and banking operations around the world have grown in an unmatched proportion in both size and area of network. There are two reasons behind this. One, this gives high return to capital, therefore flow of capital gets the direction to have that. Two, production of consumer items in the world economy has been piled up at a much faster rate than the increase of aggregate income of the people as a whole. Therefore, rapid credit expansion has been a response to both demand and supply needs.

Nevertheless, size of credit market amongst urban high and middle-income group becomes too little with respect to the high rate of accumulation of Bank capital. In this context Grameen Bank model has in fact opened up a vast market for finance capital. The poor, until today, the majority of world population, are being kept outside banking net by collateral conditions. Although there have been many initiatives around the world to build for collateral free credit net, BRAC in Bangladesh or SEWA in India have started similar programmes around same time, Grameen Bank has been probably the first one that could attract world attention.

While Muhammad Yunus must be credited highly for his contribution in innovation in banking and opening up vast sea of market for the huge accumulated finance capital, linking of poverty alleviation with this corporate success is ridiculous and may not very innocent one.

Poverty 'alleviation' agencies and the old ideology Poverty 'alleviation' became an agenda of 'development' in the early 70s after poverty-friendly growth exercises reached its peak in the 1950s and 60s. After finishing the job of Defense Secretary of the US Robert McNamara, the war manager in Vietnam, took the charge of global development as President of the World Bank! During his tenure in the World Bank, he initiated new file, the poverty. His speech in 1973 reflected the new inclusion in policy package of the World Bank. It was followed by increasing flow of fund 'targeting' poor for carrying out research in measuring poverty and establishing poverty 'alleviating' programmes.

The growth of new breed of Non Government Organizations (NGO) s in the peripheral countries, wholly depended on western fund, had a link of this policy emphasis in capitalist centre. It should be noted here that the development NGOs were not the first organizations assigned to address rural poverty in Bangladesh. The rural development efforts, since 1960s, e.g.Comilla model, IRDP or Swanirvar can be safely mentioned as the predecessor of NGO experiment. The failure of these attempts to alleviate poverty and to attain other goals is well documented in Akhter Hamid Khan's memoirs, who was one of the pioneers. In the 70s, after non-sustainable performances of earlier models, the viability of the dominant models faced challenges. Growth of NGOs in global scale as well as in Bangladesh is an outcome of searching of improvised version or an alternative.

The growth of Non-Government Organizations (NGOs) in Bangladesh has been spectacular since mid 70s. NGO model of development in Bangladesh, which includes group formation, the target group approach, participatory development, and micro credit, has added a new dimension to development thinking. The model is treated by global institutions (wrongly called donors) as a safety net for the people (actually for themselves?), who are the victims of other development measures prescribed by the same institutions. Horizontal expansion as well as qualitative changes in its composition characterized the last thirty years of their activities. Initially, NGOs appeared with a promise to work on social issues, struggle against exploitation and discrimination, work outside the domain or influence of local or national power structure. Since early 1980s, micro credit operations started getting priority among some NGOs and by early 90s, it became main focus of most of the sectors. Moreover, NGOs with polarization in itself gradually have found their proper place as part of corporate world.

In the process over two decades, NGOs became polarized between few very big NGOs and many small, where the small ones were reduced to subcontractors of the big. The big NGOs have become corporate groups as well. Big NGOs are also in the process of forming alliances with multinational corporations. To give a few examples: BRAC work with UNOCAL and Monsanto; the Grameen Bank, the Bank in NGO model, initially intended to work with Monsanto but failed due to resistance, has now been intensely working with multinational telecommunication company. Recently it has started a project with Denom, the French food company. All in the name of 'poverty alleviation'! It is therefore not surprising to find Muhammad Yunus always advocating for
privatization of public institution or services and liberalization of the economy in favour of global corporates.

One of the major promises of the NGOs was also to initiate a new development paradigm in contrast to poverty- friendly dominant development paradigm. Soon NGOs became largely concentrated in credit operation and export-oriented activities. It is correct to observe that, "The potential irony is that NGOs originally challenged the concept of 'trickle down' to help create the target group based approach. But in so doing, they have unwittingly contributed toward its reinstatement, as credit delivery has increased in importance as a key rural development input."

NGO model has been successfully captured development ideology. Its hegemony has become so absolute that media, research and academic world take the model as an obvious choice in a country like Bangladesh. Poverty alleviation became buzzword of this model. Micro credit is considered as the most important means of that. The World Bank as well as USAID in different official documents expressed high opinion about these NGOs and gave much more emphasis on the role of NGOs as delivering agencies of the International bodies. It is now also clear that, increasingly they are preferring NGOs to the Government. One can also have valid reasons to believe that the "stress on NGOs can be seen as part of the privatization strategy of the World Bank and most donors". It may be also argued that, "The role of donors in bringing NGOs and government together under their own agendas of privatization is clearly an important one in Bangladesh in shaping NGO activities."

It seems that during mid 90s the World Bank realised long run significance of micro credit in finance capital's global operation. In 1995, the Bank opened new window on micro credit. In 1996 World Bank's recommendations regarding NGO and micro credit in Bangladesh are noteworthy here. Recommendations categorically stated: "Integrate NGOs with commercial finance markets by: a) developing an appropriate regulatory framework for the financial operations of the NGO sector; (b) encouraging large NGOs to establish themselves as banks; (c) encouraging 'wholesaling' of credit to established NGOs; and (d) using smaller NGOs as brokers to mobilize self-help savings groups." In 1997 first international micro credit summit was held in Washington. In the conference, World Bank, USAID, UNDP and Citibank among others declared about their special fund for micro credit. In the last decade, not only Grameen Bank model started spreading in other countries, mainstream Banks also have started introducing micro credit in its operation. The second micro credit summit held this year assembled many big corporates together. Monsanto, Citigroup were among the sponsors.

Some findings on Micro credit at micro level

In the last few years, I had the opportunities to be involved in field studies on micro credit in fifteen villages in different parts of the country. Let me summarize some very important features of micro credit revealed in these studies. These are as follows: (a) its tiny amount keeps its use in limited areas mostly in retail trade or reinvest in credit market with higher interest. (b) The borrower of micro credit does not have to show any collateral but s/he has to be accountable to the group s/he belongs. (c) The borrower receives the amount minus some savings, about 10 per cent, and has to repay the loan in weekly installments with interest of around 20 per cent of the total. (d) Since more than 20 per cent return on the loan amount is essential to keep repayment regularly for every week, every month and every year without any break, if anything happens to break the payment or if the borrower cannot earn more or at least equal to the repayment amount, she /he becomes defaulter, which has chain effect. (e) It is assumed that, cateris paribus, as standard practice in economics, other things remain same, meaning everything will be favourable for weeks, months and years. No natural disaster, no accident, no sickness. Reality does not follow this. If anything much less than above happens, the repayment gets stuck. That happens for the majority. (f) Further hidden assumption is that the property relations, power structure, market process all favour the poor, which is proved completely wrong. (g) For every breakdown of the wrong assumptions the borrower faces helpless uncertain and burdened situation. Defaulters therefore are on the rise among the poor who are compelled to take new loans from other sources at higher interest rates.

Studies reveal that only 5 per cent of the borrowers showed improvement of their situation with the help of micro credit, those have other sources of income as well. The best investment area is found to further engaged in credit business with higher interest rate. The second best is the service sector, like small shops, rickshaw-van or retailing. I found 50 per cent of the borrower who could not improve but could retain the position but by taking loans from multiple sources. About 45 per cent could not do it at all, their position deteriorated. Many of them could not bear the burden and fled or on the way to leave the village with many liabilities on the head. If anybody looks for micro credit defaulters it is possible to find many of them amongst urban poor migrated from villages.

Other studies also have found similar scenario. In the findings of a resurvey of 17 villages under Poverty study of 62 villages a decade ago, Hossain Zillur reported that, only 19 per cent respondents informed that their conditions had improved, out of which only 5 per cent gave credit for this improvement to NGO intervention, 24 per cent informed that their situation has deteriorated while no change was observed in 58 per cent cases.

Women empowerment is an area that deserves special attention in discussing NGO process in Bangladesh. Bringing 'target group' women into credit market is specifically a success for credit-giving NGOs and Grameen Bank. This was also proved to be much more profitable as women borrowers seem more serious and consistent about repayment. The Grameen Bank and other NGOs also developed an alternative to collateral that is group responsibility; this is also an innovative success in expanding banking into rural poor. Expanding the credit net into rural areas, specially into women has also significant impact into those women's 'private' and 'public' life.

Women's overwhelming majority in micro credit receivers is considered as one of the biggest achievement of the endeavour. However, due to patriarchal setting the net user of micro credit has been male in most of cases, as high about 80 per cent in our study areas. In many areas, Grameen Bank and other micro credit institutions deal unofficially with real users, the male. Rate of defaulting among borrowers also have been increased. According to a study, rate of repayment will come down to 40 percent, against 98 per cent as claimed, if rescheduling considered. This may be the reason that makes Grameen to gradually shift its attention to other investments and other income groups including better off amongst poor.

Bringing credit to the poor as a major, sometime lone, determinant of development and poverty alleviation echoes the dominant development strategy of the 50s, which singled out capital scarcity as the major determinant of underdevelopment of the post-colonial countries. It emphasized that capital was the "missing component" of those countries. Needless to say, that theory has been used to rationalize export of capital and flow of foreign 'aid' from the centre capitalist countries to the peripheries.

The new myth

Even with contradictions within the system and limits to a great extent, one cannot deny substantial role that micro credit has played in some areas in the last two decades. That has developed alternative credit institution, brought women as worthy borrower, that has weakened the assertive power of traditional mohajons (money lenders) in some places.

However, one could be skeptical to equate 'access to credit' with 'empowerment'. Despite credit's role in giving women member more space into private life and her relative mobility into social life, one could raise questions about its limit. Credit programme offers women the jobs that she is already accustomed to, in that sense it cannot create that mobility of women to go beyond that limit. Secondly, many male members of the family take the opportunity to use female member to get access to the money. The credit here becomes another dowry. Shamim Hamid rightly pointed out that, "amongst the NGOs, Grameen Bank, BRAC and Proshika have gained international reputation for involving large numbers of women. However, none have achieved significant breakthrough in helping women to move to higher productivity or to activities with higher economic returns."

One NGO official has told rightly that the main objective of micro credit has been to 'link poor to the market'. The more marketization of rural economy today certainly has got momentum from micro credit. But the questions remain, why this link fails to make any significant impact on poverty at macro level? Why despite huge success of micro credit people in distress keep migrating to urban centres? Why monga type situation persists? Moreover why number of people under poverty line keep rising with rising micro credit and allocation in poverty alleviation programmes? One must look at potential of micro credit keeping these facts in mind.

Poverty has its roots and causes, expanding credit net without addressing the causes may satisfy Pareto optimality but not affect poverty situation. Experiences show that if countries like Bangladesh rely on micro credit for alleviating poverty, poverty will certainly remain to keep the programmes alive.

Along with scenario of sustained poverty, these success and failure, achievements and limits of micro credit also proved that, poverty, deprivation, illiteracy, environment, malnutrition, insecurity, gender subordination, unexplored productive potentials need much more than mere money flow in various forms. Intervention into present condition and change it significantly demand structural change, national initiative and social mobilization. These certainly call for a radically different development paradigm.

Grameen Bank or micro credit is no more a Bangladesh phenomenon, it has gone global. Inspired by neo liberal ideology World Bank literatures and Economics textbooks now refer micro credit experience as a success story of market fundamentalism. A new myth has been created in this regard. For people really want to address poverty, it is naive to feel happy about Nobel Peace Prize for micro credit by seeing it as a victory for alternative. This is not alternative but supplementary to the dominant development paradigm. With awarding Muhammad Yunus with Nobel Prize, the whole neo-liberal regime has now got a new impetus to push for more corporate grabbing, a machine for poverty reproduction, by showing the victims micro credit as their Aladdin's lamp.


Not a question of quality alone, a question of need as well


Not a question of quality alone, a question of need as well Tanim Ahmed

Feeding capsules and tablets would not preclude the need for them in the future but deepen one’s dependence on them, furthering the possibility of profit for the manufacturers. And by running the vitamin A campaign, the government may actually becoming a tool of corporate profit while reneging from its more serious responsibility

THERE have been three reported deaths till Wednesday. Thousands of children reportedly fell sick after taking vitamin A capsules and de-worming tablets. A government appointed committee began its investigations on Tuesday. According to reports, samples of the two drugs have been sent to laboratories for testing. But the health minister knows better. He reassured the parliament, and thereby the entire country, that those capsules and tablets had nothing to do with the deaths. And by making the statement he has also compromised the outcome of the investigation of the government committee.
This committee, headed by the director of the government’s primary healthcare directorate is expected to submit a report within three days. But now that the health minister has committed himself, it would be unlikely that the investigation would find something contradictory to what the minister stated and in turn make him look like a fool. One might still point out that the laboratory tests abroad would surely be neutral. Not necessarily. According to a New Age report published on Wednesday, the samples have been sent for tests to laboratories of the manufacturers of those medicines through the agencies that supplied them.
The report states, quoting sources in the health directorate, ‘initiatives had been taken to send the samples of the vitamin A capsules to Copenhagen in Denmark for laboratory tests through the UNICEF, which supplied the medicine produced by a company in Copenhagen’. Regarding the chewable de-worming tablets it states, ‘The samples of Albendazole have already been sent to Incepta Pharmaceuticals Limited, which produced and supplied the drug, asking the company to report the directorate after laboratory tests.’ The conflict of interest is obvious. The tests reports would hardly find anything amiss, as far as the quality of those medicines is concerned.
One must accept, until it is established that the drugs were of poor quality, that the deaths might have resulted due to other reasons. The World Health Organisation and the United Nations Children’s Emergency Fund, have both issued statements that suggest their conviction in the good quality of these medicines. There have been instances before when companies have shipped batches of products, including medicine and baby food, to poor countries in South Asia and Sub-Saharan Africa despite good knowledge of the poor quality of those products. One cannot but recall the instance of Norplant distribution in Bangladesh under USAID project for birth control even after they were discontinued in the United States and the manufacturer was facing thousands of class action suits.
More recently, there was the melamine scare in children’s milk powder. Although melamine is not a naturally occurring substance in milk, none of the brands that were initially found to have been adulterated with melamine were punished. The companies got away on a technicality, on the one hand dismissing tests that found significant traces of melamine while on the other accepting reports that could not find melamine over the ‘detectable limit’. All parties involved in the vitamin A capsule and the de-worming tablets can be expected to vouch for the quality of the medicines with all certainty. After all, these are commercial products. Even the government, as it already has, is likely to defend the quality of those drugs since the prime minister herself inaugurated the programme on Friday.
But amid all the hype over whether the drugs were indeed responsible for the three deaths and thousands taken ill, it is not being questioned whether administering vitamin A and de-worming tablets to almost all the children below 5 years of age is at all necessary. Vitamin A deficiency causes the death of some 670,000 children, according to reports quoting the statement of international agencies. Night blindness is said to be one of the first symptoms of vitamin A deficiency and the health secretary reportedly told the media on Thursday that child blindness was not a serious problem in Bangladesh. According to estimates that he cited to the press on June 4, only about 0.04 per cent of the children currently suffer from night blindness.
According to the report in New Age, the vitamin A campaign covering 20 million children would cost the government about Tk 14 crore, including the cost of medicine. The argument would be the same in case of the de-worming tablets. It is not the entire population of Bangladesh’s children that have worms and those with a higher risk of having worms could easily be screened for de-worming. In this case the state is undertaking a large-scale intervention targeting the entire population of children although the real requirement is only a fraction of that.
Identification of children suffering from night-blindness or those with a higher risk of having worms would substantially reduce the costs, not to mention the logistical problem of proper storage and administration. But such screening and identification would drastically reduce the amount of medicine required in turn reducing the prospect of business for the manufacturers. It appears that one of the driving forces behind conducting this programme across the country is commercial profit for these companies.
One gets the impression that this programme is being lauded by international quarters. At least it is not being criticised in any way. But similar programmes where the state targets the entire population through some intervention is always frowned upon by international quarters who then urge that the state must ‘target’ the more deserving groups — fuel subsidies being one of those instances in recent memory.
The ‘necessity’ of such supplements of nutrients that are generally available in balanced diet is often extolled through concerted efforts of the vested quarters. A seminar jointly organised on July 23, 2008, by the health ministry, Micronutrient Initiative, Johns Hopkins University, USAID, Brac and Helen Keller International, said as many as 20,000 lives of infants could be saved every year in Bangladesh if all newborns are provided with a dose of oral vitamin A each shortly after their birth. According to a report published in the Daily Star a day later, experts there claimed that a certain ‘safe’ dosage of vitamin A for newborns, costing only Tk 2, could save thousands of lives. Never was it mentioned there, that infant up to six months should not require anything, not even water, besides breast-milk.
It is the contention of experts that such interventions as the vitamin A campaign could become necessary in certain regions and only in such extreme cases as famine or natural disasters. This campaign is only an ad hoc measure. Feeding capsules and tablets would not preclude the need for them in the future but deepen one’s dependence on them, furthering the possibility of profit for the manufacturers. And by running the vitamin A campaign, the government may actually becoming a tool of corporate profit while reneging from its more serious responsibility.
Even a brief perusal of the natural sources of vitamin A – which include sweet potato, spinach, leafy vegetables, pumpkins, papayas and mangos – should suffice to demonstrate the commercial motive behind the campaign. Instead of fulfilling its obligation to ensure balanced diet for pregnant and breast-feeding mothers as well as children, or ensuring proper hygiene for the children, the government opted for a band-aid measure which would also ensure visibility in the media. An awareness programme regarding balanced diet and hygiene or the gradual improvement of diet and hygiene could hardly provide for such populist mileage.