According to the story, most people living in Eastern Africa (and many other developing regions) have traditionally obtained medical devices and equipment largely through donor-funded initiatives. These efforts may in fact do more harm than good. “The majority of the equipment is literally dumped into the African continent by suppliers who are funded through donor agencies. Indeed, close to 75% of medical equipment donated from industrialized nations are not in usable condition six months after arrival. Some 25% have major defects, another 50% fail progressively due to age or lack of proper maintenance.”
As bad as the short-term consequences of this type of development assistance can be, the long-term costs are even higher. By shifting the burden to relieve the problem out of the hands of the people affected, this current approach to development stifles the capacity for a country to meet their own needs independently of outside assistance.
“The dependence on donors to give equipment destroys any industry that happens to be present in the country.” This destruction of markets for local products “makes it even harder to think of creative ways of providing access of local products to the market.”
I’ve heard similar arguments from other development practitioners, and not just those in the healthcare field. A colleague from South Asia once told me, “what this country needs is more struggle and challenges, not less. People get used to having things done for them. Need a new road? No problem, just ask the Japanese. Need a new job program? Go ask the Dutch. Development aid creates a dependency mindset, a belief that someone else will always be there to solve your problems, so there’s no need to worry about them yourself.”
That’s one of the reasons I find the ‘development through enterprise’ model so appealing. It’s not just about creating the capacity to consume, but also the capacity to produce locally for local consumption. The approach generates jobs in the short term, and more importantly, engenders the ability to innovate and create new jobs in the long term.
KDNC is doing just that. The group has begun a new program for development of sustainable medical device manufacturing in Kenya. “The plant will serve the needs for local medical devices and equipments in the region; and serve as an outsourcing unit for medical device suppliers in the industrialized nations.”
Other initiatives with similar goals include Aavishkaar and the Rural Innovations Network in India, as well as Amy Smith’s work at MIT on designing for the BOP. The success of such initiatives may portend a broader adoption of this developmental approach, one that creates empowerment and not dependency.
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Thank you very much for your review. Development through enterprise is the ONLY way development can take place. Current development models and concepts that encourage pouring of donor funded products into a country cause extensive damage to the local people. It is now very clear that such initiatives do not meet any human needs what so ever. Instead, pouring of products in to any country only helps the proponents of the projects, and the products manufacturers. This would not be too bad, if making a few people rich was all it did. The problem with pouring products into a country, however, is the destruction of the local markets, and the undermining of the local capacity for entrepreneurship that it entails. Again, this would not be a problem, if destruction of local markets, and undermining local capacity for entrepreneurship were all it did. The problem is that destruction of local markets, and inhibition of local capacity for entrepreneurship embarrasses the income generating opportunities of the local people, driving hundreds of thousands of people into the abyss of poverty.
This is exactly what many well-intended poverty reduction, and disease reduction campaigns have done to millions of people living in developing countries. Some people call that Development Traps. With all the good intentions, many poverty reduction efforts have literary driven millions in to poverty. Many interventions designed to fight diseases like malaria, TB, and HIV, have been responsible for sharp rise in incidence of death due to these diseases. In a crazy paradox, the increase in mortality follows increased efforts at interventions.
The reason why this happens is simple. A case in point is the malaria control programs. With all good intensions, in 1998 the WHO, partnered with UN, and UNDP to create a Global Fund to FIGHT malaria, TB, and HIV. In this campaign, the Fund went shopping for products to fight these diseases. The idea was to distribute millions of insecticide treated nets and free antimalaria drugs to millions of people in Africa.
Consequently, many African countries received millions of mosquito nets impregnated with synthetic pyrethrins manufactured in Japan. Millions of antimalaria drugs were also distributed.
ADVERSE EFFECT: The effect of flooding the market with these two products was the complete destruction of markets for natural pyrethrins, which grows naturally in many equatorial highlands. Millions of pyrethrum farmers were thrust deep into poverty as their product faced stiff competition from a giant multinational coming in with big dollars from Global Fund.
Distribution of free antimalaria drugs effectively wiped out the malaria retail market in the countries involved (drugs are now free) destroying means of livelihood for families who depended on the economy built around malaria treatment.
There are hundreds of thousands of examples everywhere where well intended programs wide-up destroying millions of people. In deed, many development programs have resulted in extensive loss of human life. The mortality rate increased dramatically in all developing countries following structural development programs of the 80's.
Yet, many development programs enrich many individuals and corporations from developed countries.
Critical lesson for poverty reductionisms: To use Systems Thinking Tools developed by people like Peter Senge, and the Society for Organizational Learning to predict the effect of their actions. Creating intervention programs that wide up killing people is the worst kind of creation.
For a development program to result in development, rather than destruction of human life, they must be based on the needs of a human being, rather than based on the needs of a disease like malaria, TB, or HIV. Or the needs of poverty, for this is how the current development thinking works. Until the human being is included in the plan, such interventions, and donations will continue to ruin means of livelihoods of millions, causing more poverty, disease, and death. Unleashing the capacity for entrepreneurship at the local level is the ONLY way that local development can take place. This has to be done genuinely, with genuine understanding, and deep appreciation of the TRUE needs of the people.
Macharia Waruingi, MD