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By Dambisa Moyo . London : Allen Lane . 2009 ISBN 978‐1‐846‐14006‐8 . 188 pages . RRP$32.95 Reviewed by Gavin Mooney Professor of Health Economics, University of Cape Town, South Africa and Honourary Professor, University of Sydney, New South Wales This is a book that has received an enormous amount of publicity. That is, perhaps, not surprising. It suggests among other things that aid to Africa should be stopped. That is certainly a way to get the book attention! In public health terms to suggest that seems rather weird. How can it be that cutting off aid would be a good thing for the health and wellbeing of the peoples of Africa? We are all versed in the social determinants of health and all want Africa lifted out of poverty. Arguing that aid is bad is surely not the way to go. Moyo, however, argues that it is. I think she is wrong. Niall Ferguson at the very start of the foreword writes how ‘so much of the public debate about Africa's economic problems [is] conducted by non‐African white men’. He goes on to say that the fact “that Dead Aid is the work of an African black woman is the least of the reasons why one should read it … but it is a good reason nonetheless”. If Ferguson really believes it to be the least of the reasons, why is it the first thing that the reader reads? But the combination of a black African author and a recommendation to stop aid to Africa is just the sort of messenger and message that the West wants when it is struggling to deal with its own problems from the global meltdown and keen to find some justification for reducing the ‘burden’ of its aid giving to Africa and the rest of the world's poor. Ferguson also writes: “this is quite a book”. He is right but why it is quite a book is something that he, in lauding it, and I, in criticising it, would disagree about very strongly. Let me come to the core of the book. In several places Moyo argues that lots and lots of aid has been given to Africa. For example (p17): “By the end of the 1970s Africa was awash with aid.” The whole thesis of the book is that this aid which was and is swilling around Africa is making Africans welfare – or aid – dependent. Naughty Africans! Time to stand on your own feet! There is just a slight problem with this. Certainly many of Moyo's criticisms of aid are justified but they are hardly new. It is the leap to the answer being to stop aid that has made the headlines and made the book a potential best seller and made Moyo the darling of the west. “Ah now we have an African – and a woman at that – who gives us the ammunition to reduce or even cut off aid!” The author worries about all the billions of aid that have poured into Africa. She quotes Rwanda's President Kagama saying: “While more than US$300 billion in aid has apparently been disbursed to our continent since 1970, there is little to show for it in terms of economic growth and human development”(p28). President Kagama is right. There is little to show for it. But stop aid? No; stop and do some simple arithmetic. US $300 billion over 40 years amounts to less than 3 cents a day for every person in Africa! The average income in sub‐Saharan Africa is a dollar a day. The people there must be so grateful to the aid givers that it is not just 97 cents. Their ‘aid dependency’ is an ‘awashing’ 3 cents a day. What of Moyo's remedies? Her ‘capital solution’, which would be achieved through African countries issuing bonds, requires these countries to get credit ratings sufficiently high to get someone to buy their bonds. How are they to do this? If they could, surely they would. But there are no policy options from Moyo on how to get good credit ratings except to get off aid dependency. In the chapter ‘The Chinese are our friends’ she rides roughshod over any moral arguments that might be raised here. ‘Let's trade’ is a strategy that many would agree with and here Moya gets closer to the reality of western intransigence. She points to the fact that ‘each European Union cow gets $2.50 a day in subsidies, more than what a billion people, many of them Africans, each have to live on every day’. Yes, disgraceful and 80 times the aid ‘subsidy’ for Africans. But it is not exactly a new thought or comparison; nothing to do with aid and nothing to do with African responsibility. It is all to do with the West's miserly policies towards Africa and the West's protectionism. Sub‐Saharan people matter much less than cows, European Union cows that is. Moyo supports the idea of the Grameen bank and points to its many successes. Who does not support the idea of the Grameen bank? Nothing new there. She indicates (p73) that her proposals “are financing solutions that have their roots in the free‐market system”. She continues: “This invites the question: is it possible for a government to raise money in a free‐market way and spend it on a socialist agenda (for example, provide free education and healthcare)?” She responds: “The answer is yes: Sweden, Denmark and Norway are just three examples.” There is some odd reasoning here in addition to some need to question if the three countries named are socialist! And so it goes on. I worry about this book and the damage it might do to the wellbeing and health of African peoples. I am writing this review in South Africa. The country is struggling not because of being ‘awash with aid’ but because of the neo‐liberal policies it has pursued and which Moyo advocates for Africa as a whole. Poverty in South Africa is as bad here as in 1994; inequality worse not because of aid but because there is no trickle down from neo liberalism but only gravity‐defying trickle up as has been seen in the past in South America and elsewhere. The issue is not aid per se as Moyo argues; it is the paucity of aid and the way that aid has been handled both by African governments and by the donors. On the amount, there is only a handful of western countries who hit the UN target of 0.7% of GNP for aid. Even 0.7% is tiny. If an economy is growing at say 3% per annum, that means giving up three months of growth money. Some of her analysis on why aid currently is problematical is sound even if not novel. There is much that is wrong with aid policies. At the donor end, this includes a lack of understanding of some of the cultural issues that Africa faces and the need to build better governance. In health, for example, building better systems is a priority ahead of specific disease programs. At the African end, corruption is a problem that needs to be addressed. I would encourage readers to read this book and not rely on the hype that surrounds it. Finally, in being critical of the central message of this book, I make no apologies for being a non‐African white male.
Australian and New Zealand Journal of Public Health – Wiley
Published: Aug 1, 2009
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