Much has been and much more will be written about the looming abolition of USAID.

It’s “the removal of a huge and important tool of American global statecraft” (Konyndyk), or the wood-chipping of a “viper’s nest of radical-left marxists who hate America” (Musk) or, more reasonably, the unwarranted cancellation of an organisation that should have been reviewed and reformed.

Commentators will have a lot to say, some of it exaggerated, about the varieties of harm caused by this decision, and about its legality.

Some will welcome it from a conservative perspective, believing that USAID was either not aligned with or acting against the interests of the United States, or was proselytising wokeness, or was a criminal organisation.

Some, often more quietly, will welcome it from an anti-imperialist or “Southern” perspective, believing that the agency was at worst a blunt instrument of US hegemony or at least a bastion of Western saviourism.

I want to come at this topic from a different angle, by providing a brief personal perspective on USAID as an organisation, based on several decades of occasional interaction with it during my time as an Australian aid official.

Essentially, I view USAID as a harried, hamstrung and traumatised organisation, not as a rogue agency or finely-tuned vehicle of US statecraft.

Peer country representative
My own experience with USAID began when I participated as a peer country representative in an OECD Development Assistance Committee (DAC) peer review of the US’s foreign assistance programme in the early 1990s, which included visits to US assistance programmes in Bangladesh and the Philippines, as well as to USAID headquarters in Washington DC.

I later dealt with the agency in many other roles, including during postings to the OECD and Indonesia and through my work on global and regional climate change and health programmes, up to and including the pandemic years.

An image is firmly lodged in my mind from that DAC peer review visit to Washington. We had had days of back-to-back meetings in USAID headquarters with a series of exhausted-looking, distracted and sometimes grumpy executives who didn’t have much reason to care what the OECD thought about the US aid effort.

It was a muggy summer day. At one point a particularly grumpy meeting chair, who now rather reminds of me of Gary Oldman’s character in Slow Horses, mopped the sweat from his forehead with his necktie without appearing to be aware of what he was doing. Since then, that man has been my mental model of a USAID official.

But why so exhausted, distracted and grumpy?

Precisely because USAID is about the least freewheeling workplace one could construct. Certainly it is administratively independent, in the sense that it was created by an act of Congress, but it also receives its budget from the President and Congress — and that budget comes with so many strings attached, in the form of country- or issue-related “earmarks” or other directives that it might be logically impossible to allocate the funds as instructed.

Some of these earmarks are broad and unsurprising (for example, specific allocations for HIV/AIDS prevention and treatment under the Bush-era PEPFAR program) while others represent niche interests (Senator John McCain once ridiculed earmarks pertaining to “peanuts, orangutans, gorillas, neotropical raptors, tropical fish and exotic plants”) — but none originates within USAID.

Informal earmarks calculation
I recall seeing an informal calculation showing that one could only satisfy all the percentage-based earmarks by giving most of the dollars several quite different jobs to do. A 2002 DAC peer review noted with disapproval some 270 earmarks or other directive provisions in aid legislation; by the time of the most recent peer review in 2022, this number was more like 700.

Related in part to this congressional micro-management of its budget — along with the usual distrust of organisations that “send” money overseas — USAID labours under particularly gruelling accountability and reporting requirements.

Andew Natsios — a former USAID Administrator and lifelong Republican who has recently come to USAID’s defence (albeit with arguments that not everybody would deem helpful) — wrote about this in 2010. In terms reminiscent of current events, he described the reign of terror of Lieutenant-General Herbert Beckington, a former Marine Corps officer who led USAID‘s Office of the Inspector General (OIG) from 1977 to 1994.

He was a powerful iconic figure in Washington, and his influence over the structure of the foreign aid programME remains with USAID today. … Known as “The General” at USAID, Beckington was both feared and despised by career officers. Once referred to by USAID employees as “the agency’s J. Edgar Hoover — suspicious, vindictive, eager to think the worst” …

At one point, he told the Washington Post that USAID’s white-collar crime rate was “higher than that of downtown Detroit.” … In a seminal moment in this clash between OIG and USAID, photographs were published of two senior officers who had been accused of some transgression being taken away in handcuffs by the IG investigators for prosecution, a scene that sent a broad chill through the career staff and, more than any other single event, forced a redirection of aid practice toward compliance.

Labyrinthine accountability systems
On top of the burdens of logically impossible programming and labyrinthine accountability systems is the burden of projecting American generosity. As far as humanly possible, and perhaps a little further, ways must be found of ensuring that American aid is sourced from American institutions, farms or factories and, if it is in the form of commodities, that it is transported on American vessels.

Failing that, there must be American flags. I remember a USAID officer stationed in Banda Aceh after the 2004 Indian Ocean tsunami spending a non-trivial amount of his time seeking to attach sizeable flags to the front of trucks transporting US (but also non-US) emergency supplies around the province of Aceh.

President Trump’s adviser Stephen Miller has somehow determined to his own satisfaction that the great majority (in fact 98 percent) of USAID personnel are donors to the Democratic Party. Whether or not that is true, let alone relevant, Democrat administrations have arguably been no kinder to USAID than Republican ones over the years.

Natsios, in the piece cited above, notes that The General was installed under Carter, who ran on anti-Washington ticket, and that there were savage cuts — over 400 positions — to USAID senior career service staffing under Clinton. USAID gets battered no matter which way the wind blows.

Which brings me back to necktie guy. It has always seemed to me that the platonic form of a USAID officer, while perhaps more likely than not to vote Democrat, is a tired and dispirited person, weary of politicians of all stripes, bowed under his or her burdens, bound to a desk and straitjacketed by accountability requirements, regularly buffeted by new priorities and abrupt restructures, and put upon by the ignorant and suspicious.

Radical-left Marxists and vipers probably wouldn’t tolerate such an existence for long. Who would? I guess it’s either thieves and money-launderers or battle-scarred professionals intent on doing a decent job against tall odds.

Robin Davies is an honorary professor at the Australian National University’s (ANU) Crawford School of Public Policy and managing editor of the Devpolicy Blog. He previously held senior positions at Australia’s Department of Foreign Affairs and Trade (DFAT) and AusAID.

Article by AsiaPacificReport.nz

Late last month, New Zealand Health Minister Andrew Little stated what most who work in health already know.

Healthcare is all about people – the people being cared for and the people doing the caring.

Population growth, ageing and a pandemic mean there is no shortage of those needing care, but in New Zealand and globally, there is a chronic shortage of healthcare workers.

Little stopped short of calling it a crisis, but researchers and international agencies alike agree with a survey of New Zealand doctors that the health workforce is in crisis.

In 2016, the World Health Organisation (WHO) projected a global shortage of 18 million healthcare workers by 2030. That was before the covid-19 pandemic. Between 80,000 and 180,000 healthcare workers have died globally during the pandemic’s first 16 months, according to the WHO’s conservative estimate.

“Public statements from political leaders that there is ‘no crisis’ in the health system have seemed increasingly out of step with doctors’ experience over the past year” https://t.co/dXMhA38XIO

— Emma Espiner (@emmawehipeihana) July 11, 2022

Add to this the impact the pandemic has had on the mental health of frontline health staff, including reports of post-traumatic stress disorder (PTSD), and a healthcare workforce seven times more likely to have severe covid and now carrying the burden of long covid.

It’s clear healthcare is no longer the attractive sector it once was.

A highly mobile workforce and a global shortage
Like the cost-of-living crisis, the health workforce shortage is not unique to Aotearoa New Zealand.

This year’s budget included NZ$76 million for medical training and primary care specialists, but doctors who started training this year will not be specialists until 2034.

Meanwhile, Labour’s solution is to undertake an international recruitment drive. It is hailing New Zealand as one of the easiest places in the world for healthcare workers to come to. But are our newly opened borders attractive enough?

Overseas recruitment drive for nurses gains ‘good response’ https://t.co/RZrM4fW67L

— RNZ News (@rnz_news) July 13, 2022

In my health economics lectures I often use an anecdote about the Indian doctor who gets a job in the UK (colonial ties and a multicultural society), the British doctor who moves to Canada (less administration and more family friendly hours), the Canadian doctor who moves to the United States (specialists have much higher earning potential), and the US doctor who undertakes missionary work in India.

This highlights two issues: the health workforce is highly mobile and employment isn’t always about money. Aotearoa New Zealand is competing in a global health workforce market, and minister Little recently acknowledged the health sector as “fiercely competitive”.

But this isn’t a new phenomenon for New Zealand.

The health workforce in New Zealand has one of the largest shares of migrant workers, with 42 percent of doctors and almost 30 percent of nurses foreign-born (second only to Israel and Ireland, respectively). This is much higher than the aggregate estimates showing one in six doctors practicing in OECD countries studied overseas.

The OECD estimates the number of foreign-born doctors and nurses in OECD countries has increased by 20 percent, twice the growth rate of the overall increase across the workforce. This is what is most concerning.

The health workforce is not equally distributed. Migration of workers from low- and middle-income countries to high-income countries like Aotearoa New Zealand is a real threat to achieving universal health coverage and sustainable development goals.

New Zealand needs to be mindful that promoting our open borders is not at the expense of under-performing health systems with much greater need.

Losing healthcare workers to Australia
Outflow is also a problem in New Zealand, with New Zealand-trained doctors and nurses crossing the Tasman every year. Add to this the international recruits leaving New Zealand for Australia and there most definitely is a health workforce crisis.

As our nearest neighbour, Australia is aggressively recruiting staff. And like pavlova and Phar Lap they are happy to claim what is ours as theirs. An easier route to citizenship and voting rights will make Australia even more desirable.

How can New Zealand compete in this market? Minister Little refers to encouraging New Zealanders to return home, including lifting their pay. Research shows it’s not all about income. Location and professional development opportunities are important factors when choosing career moves.

The healthcare reforms helped tempt me back to New Zealand after 22 years away. Perhaps working in a system which has equity as its focus may encourage those who are clinically trained to return as well.

There is considerable research to inform policies around retention and recruitment. The New Zealand Ministry of Health may wish to look to the UK, which was historically dependent on EU health and care workers and now has a health workforce depleted by both Brexit and the pandemic.

In the recent LSE-Lancet Commission on the future of the NHS, British scholars argued a sustainable workforce needed integrated approaches to be developed alongside reforms to education and training that reflect changes in roles and the skill mix, and more multidisciplinary working.

The LSE-Lancet Commission authors flagged the need for better workforce planning. New Zealand’s approach to workforce forecasting has also been criticised previously.

Planning aside, a possible solution worthy of discussion is the required skill mix of the workforce, particularly with technological advancements and changing health needs. For example, the introduction of non-medical prescribers has improved job satisfaction, released clinical time and increased patient access.

New Zealand’s once-in-a-generation health reforms offer a logical time to undertake workforce reforms. We need to learn from our own historical mistakes and avoid disconnecting the workforce from the policy reforms.

If minister Little and the ministry are to solve this, he will first need to admit there is a health workforce crisis.

Aotearoa New Zealand is unfortunately not alone in its quest to adequately staff healthcare, but the transformation of the health sector to create a more equitable, accessible, cohesive and people-centred system means New Zealand is uniquely placed to put those people who deliver care at the centre.

Dr Paula Lorgelly is professor of health economics, University of Auckland. This article is republished from The Conversation under a Creative Commons licence. Read the original article.

Article by AsiaPacificReport.nz

New Zealand’s leading daily newspaper has praised the “gift of inspiration” over global cooperation in launching the James Webb space telescope at the Christmas weekend, but has decried the failure of the international community to seriously tackle the growing covid-19 public health crisis cooperatively.

The New Zealand Herald declared today in an editorial that the timing, cooperation, and development work involved launching the successor to the Hubble telescope “is in marked contrast with the still muddled, individual country-based approach to the pandemic”.

The launch also could not help but “signify the yawning gap between what people are capable of and what they commonly settle for”, the newspaper wrote.

The launch of the James Webb telescope was a collaboration between the space agencies of the United States, Europe and Canada with people from 29 countries having worked on the project, reports AP.

“It blasted away from French Guiana on a European Ariane rocket. As with previous space missions, it involves vision, ambition and precise calculations that have to work perfectly to pull it all off,” the Herald said.

“The telescope has a 1.5 million km journey ahead, far beyond the moon, with a task of eventually gazing on light from the first stars and galaxies.

“It all hinges on the telescope’s mirror and sunshield unfolding on cue over nearly two weeks, having been tucked away to fit into the rocket’s nose cone.

“If that goes right, the telescope will be able to look back in time a mind-boggling 13.5 billion years.”

Fascinating year for science
The US$10 billion telescope project had capped a “fascinating year for space science” after the “incredibly precise landing of a rover and a helicopter drone on Mars, which resulted in the first powered flight on another planet”, said the Herald.

Noting Nasa’s science mission chief Thomas Zurbuchen’s comment welcoming the launch — “what an amazing Christmas present” — the newspaper contrasted the collaborative achievement with the “muddled, individual country-based approach” over covid-19.

“While the rocket was launching humanity’s imaginative time machine, hundreds of thousands of people on Earth were getting a ‘gift’ of covid at Christmas. Both Britain and France hit more than 100,000 cases on Saturday,” the Herald said.

“The cost of the space project is tiny compared to the US$725 billion the US spent on defence in the 2020 financial year — more than the next 11 countries combined. Next year’s bill is US$770 billion.

“It is closer to the US$50 billion amount the OECD has estimated it would cost to vaccinate the world’s population against the coronavirus and protect the global economy.

“Far more money than that — US$12 trillion — was spent by countries in financial support between March and November 2020.

Time to hatch global covid plan
“Although that support was urgently needed, surely there was also time to hatch a US$50 billion global plan for a coronavirus endgame before the vaccines came on stream in late 2020.

“Now, a year later, each country is dealing with the omicron wave its own way, and progress in distributing vaccines to poorer regions is slow. People feel frustrated the vaccines haven’t guaranteed a return to life as we knew it.

“The vaccines themselves are an amazing scientific achievement: developed quickly and still doing their job of protecting the vast majority of vaccinated people against severe covid disease.

“A study by the World Health Organisation and a European Union agency estimated in November that the vaccines had saved nearly half a million lives in a region of 33 countries.

“But it is hard for people to really absorb achievements that involve prevention: When they work as hoped, at least some people believe it’s proof the threat was overblown.”

Article by AsiaPacificReport.nz