GLOBAL HEALTH CERTIFICATE

Module 4: Pitfalls in Development Work

When the United Nations Children’s Fund (UNICEF) started a project to improve access to clean drinking water in Bangladesh in the 1970s, the locals refused to use the new water wells, which they believed were pumping the “devil’s water.” While the local communities knew that the well water was unsafe, they were urged to use the well water, which was believed by the development workers to be safe. However, Bangladesh now has an outbreak of mass arsenic poisoning due to drinking the water from these wells.(1) Those involved with development work must understand cultural beliefs and local knowledge. In the case of Bangladesh, those involved with the water development project dismissed the local knowledge about the underground water, which has led to tragic results. Aid workers often venture into indigenous communities hoping to create positive change. Despite their good intentions, however, their poor implementation strategies often spell failure for much of development work, leading to the waste of large amounts of foreign aid that are channeled into development programs each year.(2) It is therefore crucial to recognize the common pitfalls in development work, as well as the importance of community involvement.

Pitfall #1: Lack of Community Involvement

At a remote African village, Pierre, a foreign aid worker, plans to build a mill to reduce the heavy workload of the village women (though a mill already exists, run by a local). However, he knows nothing about the local culture and language. He does not ask any questions, and no one tells him anything. His project is supposed to empower the village women, so men are not allowed to claim ownership of the mill, even though they are expected to contribute construction labor. He is unaware of the discord, jealousy, and hatred that characterize the village politics, dividing the community. After a long delay, the mill is finally complete. But when the mill breaks down not long afterwards, no one repairs it, so it is left to rot in the sun. Meanwhile Pierre has gone somewhere else, starting yet another heartwarming project in the Global South.(3)

This anecdote vividly illustrates the various pitfalls in overseas development work. All too often, there is a poor understanding of local culture and gender norms, insensitivity towards local needs, imposition of Western structures and values, and a lack of maintenance mechanism to ensure project sustainability. These pitfalls result from the failure of the aid worker to engage in consultative dialogue with the locals, causing projects to fail and resources to go to waste.   

Case Study: The Chad Cameroon Oil and Pipeline Project

The Chad Cameroon Oil and Pipeline Project, one of the largest investments in Africa, was completed in 2003.(4) It is a classic example of what happens when development work is implemented in a top-down approach without engaging the local communities. Guided by poor leadership, the project was rife with corruption, and development funds were used to support rebel groups in Darfur rather than to support health, education, and rural development projects.(5) Not only were the indigenous people displaced from their homes, but their livelihoods were also destroyed. Many left their villages in search of better employment opportunities in the oilfields, crippling the local industries. Moreover, the project caused various ecological and health disasters. According to a report, “in the approximately 100 villages traversed by the pipeline route, less than 10 percent have drinking water systems; most villagers rely upon water systems susceptible to pollution.”(6) Without the close participation of the local community, a development project that is supposed to benefit the local community can end up exploiting it instead.

Case Study: The Lake Turkana Fish Processing Factory

The Lake Turkana fish processing factory was designed by the Norwegian government in 1971 to provide employment for the local people.(7) However, Turkana’s predominantly pastoral communities don’t traditionally fish. "It was the old top-bottom approach," said Cheanati Wasike, government fisheries officer for Lake Turkana. "The lake was identified by outsiders as a resource but they never consulted the Turkana people, never asked them what they thought of fishing it." The factory now stands idle on the shores of Lake Turkana as yet another reminder of what happens when local communities are not involved in the key decision-making stages of development work.(8)

Pitfall #2: Poor Donation Practices

A study to improve the usefulness of donated equipment in a Gambian hospital revealed a lack of maintenance expertise as a major issue.(9) According to the same study, donating is sometimes seen as a way for donors dispose of their old equipment, which may not even be of practical use to the recipient:

“It is estimated that up to 70% of equipment in sub-Saharan Africa gathers dust for the same reasons that these concentrators[medical equipment] did, and that at least half of all medical equipment in the developing world is unusable. Donations are a well-established method for donors to dispose of old equipment, while on the recipients’ side donations have strong appeal as ready solutions to gaps in services. Unfortunately, they can be a poor substitute for the appropriate technologies and genuinely sustainable development so badly needed in the developing world.”(10)

Poor donation practices can also lead to adverse environmental and social consequences. Often, recipient countries do not have the necessary disposal facilities to get rid of waste equipment, which may contain toxic and non-biodegradable parts. As a result, poor disposal methods can lead to environmental degradation.(11) Moreover, donated items can also have unforeseen social consequences, such as being manipulated as a political tool:

“The computer collecting dust in the village governor’s office does nothing to teach the community about technology.  However, it does drive home the message that those in power have the right to plunder from community resources. Even with our hand-me-down offerings, the rich get richer.  In a society so poor that over one third of its GDP comes from foreign aid, small possessions like sugar or an additional set of bowls may be all that separates the rich from the poor.  A computer represents an exotic trophy, worth far more than any other indicator of wealth or power.  The governor’s political opponents seethe with envy every time they enter his office. With such a symbol of authority and power in his custody, they’re unlikely to challenge his regime.  Even while sitting unused, the computer can be a political tool that divides the community, instead of uniting the community with the developed world.”(12)

Though donating equipment to resource-poor settings is a necessary component of development work, its success requires planning, technical expertise and local participation. Not only should donated items be useful to the recipient community, they must be disposed of carefully after use. Furthermore, local personnel should be trained to operate and repair the donated equipment. Otherwise, failed equipment simply gathers dust.

The Importance of Community-Driven Development

Community-driven development is centered around community needs. Consider the following excerpt of an article that illustrates the importance of matching development work with community needs:

“On September 16, 1994, Jaime Mauricio Solorzano Campos drowned trying to cross the Chiquito River [a river in El Salvador]. As a volunteer with Medicos del Mundo (local mission of Médecins du Monde, France) he was carrying used clothing to desperately needy residents of the community of Estancia in northeastern El Salvador…Community members have also suffered crossing the Chiquito River. In 1994 alone, four other people, including two children under 10, drowned here. Children must routinely cross the river to attend school. The medical student volunteers and other health care workers who help this community must cross the river during their two-hour hike up the mountain. The new bridge makes it possible to safely deliver medical and day care supplies and equipment and enables the transport of critically ill patients across the river to health care facilities nearby. The bridge also supports a large volume of pedestrian traffic, including school children and people on their way to local markets. Guillermo Candela Garcia, a volunteer Spanish engineer, designed the bridge and directed construction, which was done almost exclusively by local residents working with shovels, picks, and hand tools. Approximately half the funding was donated by the United Nations High Commission on Refugees and individuals.”(13)

This is a good example of a community-driven development project. Before embarking on a development project such as building wells and houses or donating equipment, local needs must first be identified and understood. The bridge fulfilled a community need for safety and convenience. The donor, which in this case was the United Nations High Commission on Refugees, as well as other individuals, only funded the project and did not try to intervene in the project design. The Spanish volunteer designed a suitable bridge for the community. Rather than working alone, he worked in close collaboration with the local community.

Health and development work should emphasize a grassroots approach, involving the community in key project decisions so that development work can be more responsive to their needs. Global health programs should not encourage over reliance on foreign support. Giving local partners more autonomy over development assistance will encourage them to undertake more self-initiated development activities. For instance, Unite For Sight’s overseas programs are led and managed by local eye care professionals, who are extremely knowledgeable about local disease etiologies, healthcare systems, and cultures. Not only do they build trust between the community and the visiting health professionals, local doctors can also provide follow up care, which is not possible if communities are forced to rely on visiting doctors from overseas. Without the involvement of local doctors, global health programs may undermine the legitimacy of local doctors in the eyes of the community, which is detrimental to local healthcare systems.

In conclusion, poor project implementation strategies, particularly those that emphasize a top-down approach as in the case of the Chad and Cameroon oil pipeline project, often result in gross exploitation of the indigenous people, while culturally apathetic strategies like the Lake Turkana fish project generate no interest in the local communities, leading to wasting aid. Moreover, poor donation practices, such as the donation of irrelevant equipment, can cause further waste. In order to ensure the success of development work, a bottom-up approach, which emphasizes community involvement in key decision-making and project implementation steps, should be used.

Footnotes

(1) Atkins, P., et al. “Poisons, Pragmatic Governance and Deliberative Democracy: The Arsenic Crisis in Bangladesh.”Geoforum, vol. 38, no. 1, Jan. 2007, pp. 155–170., doi:10.1016/j.geoforum.2006.07.009.

(2) See, for example, an article regarding Australian aid that was spent on East Timor but which never made an impact on the poor, https://www.abc.net.au/news/2015-09-21/henriss-address-the-oil-injustice/6790978.

(3) Notes on Anthropology and Intercultural Community Work Adapted from Carlson, Joyce. The Stranger's Eyes, SIL Mali, 1995, pp. 34–38.

(4) Grimes, K.  Environmental Justice Case Study: The Chad/Cameroon Oil and Pipeline Project. University of Michigan, www.umich.edu/~snre492/Jones/pipe.htm.

(5)“World Bank Stops Financing Chad Oil Pipeline.”Afrol News, 10 Sept. 2009, http://afrol.com/articles/30741.

(6) Grimes, K.  Environmental Justice Case Study: The Chad/Cameroon Oil and Pipeline Project. University of Michigan, www.umich.edu/~snre492/Jones/pipe.htm.

(7)“Examples of Failed Aid-Funded Projects in Africa.”NBCNews.com, NBCUniversal News Group, 23 Dec. 2007, www.nbcnews.com/id/22380448/ns/world_news-africa/t/examples-failed-aid-funded-projects-africa/.

(8) Cocks, T. “Kenya's Turkana Learns from Failed Fish Project.”Redorbit, 3 Apr. 2006, www.redorbit.com/news/science/456246/kenyas_turkana_learns_from_failed_fish_project/.

(9) Howie, S., et al. “Beyond Good Intentions: Lessons on Equipment Donation from an African Hospital.”Bulletin of the World Health Organization, World Health Organization, 2008, www.who.int/bulletin/volumes/86/1/07-042994.pdf.

(10) Ibid.

(11) Hayasaka, Elana. “Donating Technology or Trash?”Triplepoint., Boston University, www.bu.edu/sjmag/scimag2005/opinion/donatingcomputers.htm.

(12) Ibid.

(13) Doctors for Global Health | Promoting Health and Human Rights with Those Who Have No Voicewww.dghonline.org/. Accessed 10 December 2019.

NEXT: MODULE 5

PITFALLS IN PARTNERSHIPS