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Huge amounts of foreign aid end up flowing into the NGO sector, often to extremely efficient, effective, and well-run organizations. Still, every dollar of foreign aid which goes to NGOs is a dollar which doesn’t go directly to local governments. And that’s a problem.
After all, the Afghan government surely learned a lot in implementing the USAID program. If USAID had instead gone around the government, and instead asked say Partners In Health to do the same thing, then a lot of institutional knowledge about how to make the country healthier would have remained within PIH, rather than entering Afghanistan’s nascent bureaucracy.
It’s incredibly rare for individuals to target their philanthropic donations at national governments of any stripe. (The CDC Foundation is probably the most prominent exception to the rule, and it’s not exactly focused on raising small-dollar donations.)
But when you give money to US or European charities working in developing-country public health, you are in a way saying that you don’t trust the local government to deliver results, and that you’d rather give your money to, well, a white savior.
In the Afghan case, the US Special Inspector General for Afghanistan Reconstruction ended up recommending that the health program be suspended, not because it found any evidence of corruption, but just because “financial management deficiencies” meant that they didn’t know whether, maybe, some corruption might be going on. Probably a sophisticated American NGO would not have had such deficiencies. But the Afghan program was working, and working very effectively. That’s ultimately what matters. When you add NGOs to the development mix, it’s important to remember what you’re subtracting at the same time.