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Hillary Clinton's Naïve, Muddled Approach to Development

Does the Obama administration have any idea at all what it wants out of its development efforts? In a recent speech at SAIS at Johns Hopkins, Secretary of State Hillary Clinton announced Washington’s new six-year, $63 billion Global Health Initiative. She was at pains to differentiate the administration from its predecessor—yet one more recapitulation of a by now familiar trope, but one that is particularly disingenuous in the case of global health, where the Bush administration’s record actually was very good. The United States, she said, was taking a “new approach, informed by new thinking and aimed at a new goal: to save the greatest possible number of lives, both by increasing our existing health programs and building upon them to help countries develop their own capacity to improve the health of their own people.”

The secretary was already on record as claiming that the initiative would be a “crucial component of American foreign policy and a signature element of smart power.” On its face, this seems highly unlikely. Anyone doubting this should ponder the fact that one military program, the F-35 Joint Strike Fighter—a weapons platform that no one claims is needed for the counter-insurgency operations that are currently at the core of the U.S. military’s requirements—is on course to cost $325 billion, and may well go higher (the budget request for fiscal year 2011 is $11.4 billion, roughly the same as each of the six years of the Global Health Initiative). In other words, Washington is going to spend on a ‘signature element’ of its smart power less than one-fifth of what it is already committed to spending on something that even the Pentagon does not claim is a signature element of our hard power. No, money may not be everything, but 'follow the money' remains the best advice for understanding what the priorities of the American government really are.

Cost overruns are the bane of military procurement. But even at its worst, the process has no room for a program whose funding stands no chance whatsoever of covering the costs required to enable it to carry out the specified goal. Yet that is precisely what the way the Global Health Initiative is being funded seems designed to do. Even were the money remotely sufficient to fund the goals Secretary Clinton outlined in her speech, both the bureaucratic arrangements that are being instituted to run it, and the geopolitical assumptions that underpin it, are so hopelessly muddled and contradictory that even if the initiative were over-funded, it would stand virtually no chance of success.

In her SAIS speech, Secretary Clinton closed by saying that, “We’re aware of all the pitfalls and all the obstacles, internal and external.” I see no reason to doubt this. Hillary Clinton is both extremely intelligent and extremely well informed. So is Deputy Secretary of State Jack Lew, who is to oversee the program, and the new administrator of the U.S. Agency for International Development (USAID), Dr. Rajiv Shah. But in either designing or at least signing off on a program which grants authority for day to day running of the program to three separate agencies (USAID, the Centers for Disease Control, and PEPFAR, the Bush-era President’s Emergency Plan for Aids Relief), each with their own institutional interests, while calling on the resources and expertise of the National Institutes of Health, the Peace Corps, not to mention the departments of Defense and of Health and Human Services (“among others,” as Secretary Clinton said, without irony, in her speech), all reporting to Deputy Secretary Lew, the administration has laid the groundwork for a bureaucratic calamity. Rube Goldberg, call your office.

We already had a taste of this, in the immediate aftermath of the Iraq war, when Tommy Thompson, then Secretary of Health and Human Services, succeeded in carving out a role for his agency (a role for which it was manifestly unqualified) in the reconstruction and relief effort. In tandem with the fact that the Pentagon already controlled much of not just the military but the civilian reconstruction effort in Iraq as well, Thompson’s bureaucratic coup effectively undermined the role of USAID at the time it was needed most. Caught in a vise between HHS and the Pentagon, it was simply rendered incapable of working as it urgently needed to do and as, left to its own devices, it would almost certainly have been more than capable of doing.

Politicians oversimplify: Call it their professional deformation. But the oversimplifications in Secretary Clinton’s speech can only lead to the discrediting of an aid program that will almost certainly do quite a lot of good. “We invest in global health to strengthen fragile or failing states … the destabilizing impact of AIDS led the Clinton Administration to categorize it not just [sic] as a health threat but as a national security threat.” This is highly questionable. South Africa during the Mbeki years was one of the countries most severely affected by AIDS. But post-Apartheid South Africa was never a fragile state, let alone a failing one. In contrast, both Bolivia and Yemen are extremely fragile states, and yet the AIDS rate in each is very low (somewhere between 0.1 percent and 0.3 percent in both countries as opposed to somewhere between 10 percent and 15 percent in South Africa). Had Secretary Clinton been telling the truth, she would simply have said that AIDS is a contributing factor to the fragility of some sub-Saharan African states, but even there she would have had to qualify the claim by emphasizing all the other elements involved—above all the calamity of a demographic explosion and the [related] crisis of smallholder agriculture and urbanization without urban job creation.

A far graver mystification is Secretary Clinton’s claim that investments in global health are an important tool of public diplomacy. “For millions of people worldwide,” she said, “the prevention, treatment or care that the United States makes possible is their main experience of us as a country and a people. ... Giving people a chance at a long and healthy life or helping protect their children from disease conveys as much about our values as any state visit or strategic dialogue ever could.”

Where to begin? Leaving aside the astonishingly tone-deaf contrast between foreign aid and a state visit—as if any ordinary citizen, whether in the U.S. or anywhere else, gives a toss about state visits—if the secretary really is suggesting that that recipients of foreign aid in very poor countries are so childlike that they view these contributions as dispositive about the nature of America’s values and intentions, then however unintentionally, she is speaking of these adults as if they were children.

This is an old failing in the aid world. As Rony Brauman, the former president of Doctors Without Borders/France once observed mordantly, “the two groups that seem to most like being photographed with children are aid workers and dictators.” Whatever Secretary Clinton may wish to claim (I’m hoping she doesn’t actually believe this), adults, and that includes very poor, very unwell adults in very poor countries, understand perfectly well that the values of powerful states, including the United States, are invariably as complicated and contradictory as those of any other state, and that, even at the noblest, these values are often at odds with a nation’s interests.

But perhaps this hyper-conceited, hyper-complacent conviction of America’s good intention is so internalized in U.S. policymakers—even in one as intelligent as Secretary Clinton—that they are incapable of thinking clearly about how U.S. foreign aid, whether for emergency relief, health, or long-term development, is received by its beneficiaries. The administration’s wishful thinking about how its efforts to win hearts and minds in Afghanistan and, latterly, in Pakistan where a relatively large deployment of U.S. military helicopters to deliver substantial amounts of American relief assistance to people in the flood zones, has been painful to watch.

Drawing on comparisons to situations that are not really analogous, American policymakers have pointed to the spike in American popularity among Indonesians in the wake of U.S. relief efforts in the aftermath of the 2004 tsunami, and among Pakistanis in Kashmir after the 2005 earthquake. Washington, they argue, has the same opportunity today in the Swat Valley.

The problem is that the spike in popularity was just that, a spike. Five years later, America is almost as unpopular in Indonesia as it was before December, 2004, and even more unpopular in Kashmir. In the Pakistani case, it is clear that Islamic relief groups with jihadi connections got a far more lasting increase in popularity as a result of the aid that they brought to the affected areas. Long after the Americans had withdrawn, the international relief organizations had reduced their operations, and the Pakistani government had reverted to its default position of callous indifference, the Islamists were still on the ground, still gaining adherents, whether out of true conviction or, probably more commonly, on prudential grounds. And American predator drones were not operating in the quake zones of Pakistani Kashmir, as they are in areas not all that far from Swat.

Of course, America’s reliance on winning hearts and minds through humanitarian relief and development assistance is not restricted to southwest Asia. Over the lasts several years, the U.S. military has been pursuing similar efforts in majority Muslim areas in the Horn of Africa—Djibouti, Ethiopia, and, above all, coastal northern Kenya. In a brilliant paper published recently by the Humanitarian Policy Network in London (full disclosure: I am on the advisory board of the unit’s parent, the Humanitarian Policy Group), Michael Kleinman and Mark Bradbury analyze the effectiveness of these initiatives. While agreeing that “these military aid projects provide an entry point into communities that are potentially hostile to the US and its interests,” Kleinman and Bradbury conclude that the most they can actually be said to have achieved are tactical successes.

But, they add, “the idea that, by delivering aid, the US military can change people’s perceptions about the United States is premised on very simplistic assumptions. … People’s attitudes are influenced by a multitude of factors beyond the scope of aid projects, such as the relationship between the target population and the Kenyan state, their self-perception as Muslims, local leadership, the media, and, more importantly, their perception of the impact of US foreign policy, both globally and across the border in Somalia.”

Kleinman and Bradley’s conclusion is one that should be obvious but seems to have escaped the Obama administration completely, as it spins fables about what the U.S. military can accomplish in the flood areas of Pakistan, or, as Secretary Clinton did at SAIS, about the extent to which the Global Health initiative can further American policy aims globally. “Acceptance of aid,” they write, “does not automatically translate into acceptance of the policies or beliefs of the entities providing the assistance.” And they quote a religious leader in the Kenyan city of Lamu, who says of the aid program: “These projects are useful, but if their purpose is to win the hearts of the people this has not been achieved. They build faith on one side and destroy it on the other. What they are doing to our brothers in Afghanistan and Israel affects all of us.”

If passions are this intense in northern Kenya, where the jihadis are nowhere near as powerful as they are in southwest Asia or in Yemen, is it at all likely that they are less passionate in the Swat Valley, or that people there are less suspicious of America’s ‘real’ motives for providing assistance? As if that were not enough, remember that Islamist aid groups are as yet not very active, at least by Pakistani standards, in the Horn of Africa outside Somalia itself.

And yet, the U.S. government not only appears wedded to a policy that would seem to have failure inscribed on its DNA, but to trying to further imbricate the international relief NGOs in these projects, a move that, if successful (and a number of mainline NGOs are right now considering no longer taking USAID grants made on this basis), is unlikely to do much to increase American credibility but will almost certainly undermine what remains of the credibility of the NGOs and of their local interlocutors and partners.

I don’t know if Hilary Clinton, or Jack Lew, or Rajiv Shah have nicknames. But to borrow the immortal formulation of President Bush to his incompetent FEMA administrator in the wake of Hurricane Katrina: “Heck of a job [fill in the name of appropriate Obama administration senior official].”