Solomon Islands, 2010

At first sight, the Solomon Islands had all the features of a tropical island paradise – lush tropical vegetation, palm fringed white beaches, humid air, dusty roads, and clusters of dark-skinned natives gathered under spreading flame trees. Bright bougainvillea flowers grew over timber bungalows and small fishing boats floated on the calm water of Honiara harbour.

After spending many years among the war damaged buildings of Kabul, and the traffic congestion and pollution of Manila, it seemed idyllic. As I travelled by taxi from the airport – a wide empty airfield that was once a second world war military base – I wondered why anything here needed to change. Why were foreigners so keen to bring their ideas about development, investment and modernisation?

It was six years since the Australian-led Regional Assistance Mission – RAMSI – had arrived to deal with years of bitter internal conflict, and the country was still crawling with advisers and experts and other types of do-gooders. RAMSI had brought peace and security and a better police force, but it had also brought all the usual donors, such as the World Bank and the Australian government, even the EU, all promoting a comprehensive program of social, political and economic reform.   

Was this really necessary, I wondered? Why couldn’t they just leave the people alone, with their thatched hut villages and fishing boats, to live as they’d done for centuries?

I was, clearly, still quite naïve back then. A few months in the Solomon Islands soon set me right about all that romantic nonsense.

In fact, I think most of my ideas about development, and the purpose of development assistance, were probably formed during that visit. The Solomon Islands turned out to be a text book catalogue of typical developing country problems, and the donors trying to fix them turned out to be no more effective there than they had been anywhere else.

The town of Honiara became less like paradise as we came closer. The concrete and fibro buildings, many surrounded by strong metal fences, were tinged with black tropical mould. The single storey shops in the main street had metal grills on the windows and roller shutters on the doors and the footpaths outside were splattered with red betelnut spit. The harbour front, where rusty ships unloaded their cargo, was like a scene from a Joseph Conrad novel a century ago.

My hotel was built on the steep hillside behind the town and my room was at the top of 120 concrete steps, past the swimming pool and the bar and restaurant, and through gardens of bougainvillea and hibiscus. The view across the harbour from my balcony was magnificent, but the room itself, described as ‘new’ and ‘deluxe’, was neither.

The hotel also seemed to have plumbing problems. When I arrived there was no water coming from the taps and the toilet didn’t flush. I called reception to report the problem.

“What, no water!” the receptionist exclaimed in apparent surprise. “I’ll send the plumber.”

Several hours later, there was no plumber and still no water. I sat on the balcony as the sun set, watching a ship chug slowly towards the port while I waited. Several more calls to reception provoked a similar sense of astonishment and promises to do something very soon.

The water eventually started flowing during the night.

I later found out that in fact there was a chronic problem with water in Honiara, in spite of its lushness. The hotel’s water tanks were refilled every evening by the fire department truck, but the taps still ran dry during the day.

The next morning, the sky was bright blue and birds sang loudly in the tropical foliage around the hotel grounds. The sound of children at a nearby school chanting in unison floated in on a cool breeze. It still seemed like paradise.

**

I admit now that when I arrived on the flight from Brisbane I wasn’t entirely sure where I was. Somewhere out in the Pacific Ocean, obviously, but not as far out as I’d assumed. The Solomon Islands archipelago hangs off the eastern end of Papua New Guinea.  The western-most islands are not far from Bougainville and the other end reaches almost to Vanuatu. A map of the country shows little more than a vast expanse of blue ocean scattered with islands and atolls.

The main island, Guadalcanal, is better known to many people as the site of a major battle during the second world war, and the sea around Honiara is littered with the submerged wrecks of American and Japanese battle ships. Both countries have built memorials to their war dead on the hills overlooking the town, and the government hospital is still generally referred to as ‘Number 9’, having once been the US military’s No 9 base hospital during the war.

I was there, on behalf of the World Bank, to work with the Solomon Islands Ministry of Health. My job was to forecast of how much the country would need to spend over the next four or five years to provide health services. At that stage, although I knew a lot about budget estimates, I knew very little, in fact nothing, about health services in developing countries, so I was on a steep learning curve.

The head office of the ministry was a collection of single storey fibro buildings standing on metal stumps scattered somewhat randomly around an untidy compound. Various vehicles were parked haphazardly in the grounds, some of them missing their wheels. On my first morning, a woman was selling fish under a tree in the car park. Women crowded around to inspect the colourful orange and pink and silver reef fish jumbled together in a large plastic crate.

The main building in the compound was a two storey cement brick construction painted blue. It had been donated by the World Health Organisation a few decades ago, according to the plaque near the open front door. The interior was now somewhat shabby. The floors were bare timber, the rooms were divided with plywood partitions, and roughly painted book shelves sagged under the weight of ancient reports.

I was by no means the only foreign expert working in the Ministry. A team of international staff were providing the government with advice on various aspects of health policy. Most of them were funded by the Australian government under what was supposed to be a ten year commitment to improving health care in the Solomon Islands. While I was there, it was decided to make that a five year commitment and the foreign advisers were told their contracts wouldn’t be renewed.

My first appointment was with the senior health adviser. His briefing on the state of health services in the Solomons was a tale of woe and despair. Health, I found out, is a complex area of government policy. Delivering health care in a place like the Solomon Islands even more challenging.

At that time, I was told, there were only around 38 local doctors, servicing a population of almost half a million people who were spread across remote islands, in small villages without electricity or effective communications. Travel to Honiara from the more distant islands was by small plane or slow ferry making a trip to hospital in an emergency more or less impossible.

Getting trained health professionals to work in these locations was also a challenge. This was partly because there was nowhere for them to live. In order to provide a community with a nurse, or a teacher or a police officer, the government first had to build houses for them, but the logistics of doing this on distant, undeveloped islands was complex and expensive. Given the distances, and the communication problems, ensuring that local clinics had the supplies of disinfectant and bandages and medications they needed, when they needed them, was also challenging.   

These problems were compounded by the fact that the government had very little money, and it had less and less each year as the country’s previously abundant natural resources declined. The last of the valuable tropical forests had been logged and sold, and the last of the tuna in the surrounding seas had been fished out. Previous politicians had signed contracts with foreign companies to exploit local resources with little concern for the environment or future generations, often pocketing large kickbacks in the process, while generously awarding each other knighthoods. Politics and government administration were dominated by tribal loyalties and giving jobs to relatives was regarded as normal behaviour.

As a result of the lack of government resources and competence, the country was highly dependent on donors and charities to keep things going. Almost 60 per cent of all the money spent on health was provided by organisations like UNICEF and the WHO, and by foreign governments like Australia, Japan and Taiwan, and about a dozen other large donors. Between them they contributed huge amounts of money to fighting malaria and TB, providing immunisation for babies, and improving water and sanitation facilities in villages.

Meanwhile church charities operated many of the hospitals, schools and clinics. The significant religious organisations included not just Anglicans and Catholics but also the unusual and novel. The Jehovah’s Witnesses had a large new building just out of town. The Seventh Day Adventists had a big presence and were just known by their initials – SDA. Even the Baháʼís had a well sign-posted building on the road east of the city.

Recently, the government of Cuba had also become involved in the islands and had offered to train 100 extra doctors. Even more surprisingly, their travel to Havana to take up the training was being funded by Iran. The lucky students would spend a year learning Spanish and the next few years studying medicine. When they returned they would significantly increase the number of doctors in the islands. Even better, their qualifications would be recognised only in the Solomon Islands or in Cuba, making it unlikely they would leave for better jobs elsewhere, as most of the country’s trained doctors had already done.

This was the one small item of positive news in an otherwise depressing introduction. Over the next few weeks, as I met with other advisers, senior government officials, and the major donors, the story became even more grim.

**

Honiara itself, however, was a fairly pleasant place to live – for foreigners at any rate. It’s a small, sleepy town, a long way from anywhere, where life moves at a leisurely pace. The deep rhythmic thumping of reggae music from cars cruising down the main street, and young Solomon Islanders in Rastafarian colours and dreadlocks, gave it the sound and feel of the Caribbean.  

No wonder so many foreigners seemed to have set up a long term home in the islands, or anchored their boat in the harbour for an extended stay while sailing around the Pacific.

These expats, and the better off locals, shopped at the two supermarkets selling ‘exotic’ goods – things we would consider commonplace at home, like yoghurt, muesli, and apples. Afterwards they might head to the Lime Lounge, a cool café that could have been in inner Sydney, selling sandwiches and wraps and salads and good coffee to a foreigner clientele who all seemed to know each other.

In the late afternoon many met up at the Port Cruz Yacht Club, down by the beach, where leather skinned old men sat drinking in the heat under a steep thatched roof, looking out over the sea as the sun set.

Yes, it wasn’t a bad life for foreigners.

There were downsides, of course. The internet was slow and mobile phone services were unreliable. Text messages from home could take days to arrive, and local phone calls rarely connected during peak times. There were also no bookshops at all, and newspapers were hard to come by. Every Friday I paid a small fortune for a week-old edition of the Australian that had just arrived on the flight from Brisbane.

But in the overall scheme of things these were minor impediments. I could still think of Honiara as a tropical paradise.

At the busy Honiara Central Market on Saturdays, local traders displayed their produce spread out on tarpaulins on the ground in ‘heaps’, the standard unit of measurement, with prices scribbled on small pieces of cardboard. One Solomon dollar for a small pile of tiny tomatoes, $2 for a mound of little capsicums, more for a heap of sweet potatoes, pawpaws, pineapples, watermelons and giant hands of bananas. Other stalls sold bunches of greenery that looked more like floral decoration than food and strange varieties of roots and tubers.

On the ocean side, fishermen sat by rows of cool boxes with whatever they had brought up in the net that morning for sale by the pound or the kilogram, depending on what type of scales they had. Nearby, women presided over piles of clams and clusters of wiggling brown objects which, on closer inspection, turned out to be live crabs. The women ruthlessly snapped their legs and claws off and they lay on their backs, the stumps of the limbs still waving frantically.

Across the main street from the central market, the doors of the windowless ‘Chinese shops’ ushered customers into a dark Aladdin’s cave of goods. A seemingly random variety of items, anything from canned tuna to kitchen utensils to rubber thongs, were arranged beside packets of biscuits, soap and cheap suitcases, most displayed in old-fashioned glass display cases. The Chinese owner sat on a very high stool just inside the door, keeping an eye on both the customers and the local shop assistants.

At another store people queued for their chance to sort through racks of imported second-hand clothes, the outgrown and worn out items that ended up in charity bins in Australia. There were almost no shops in Honiara selling new clothes, and the women in the office told me they preferred good quality cast-offs to the cheap imports sold in the Chinese stores. As a result, most of the local population went around dressed in recycled t-shirts with slogans and logos from some long forgotten advertising campaign or charity fun run.

**

After the depressing first day briefing, I began work on compiling budget information. In many places this would take a few days but the contract had allowed several months. I soon found out why. Getting up-to-date information in the form I needed turned out to be quite difficult.

A recent administrative reform had devolved responsibility for most health services to individual provinces. The idea behind this was to give local people more say over what happened to the money allocated for health care in their area. To be effective, however, this would require strong political leadership, an effective provincial administration, and citizens who were prepared to hold their leaders to account. All these factors appeared to be lacking in this case.

Decentralisation meant that the health ministry relied on provincial offices to submit financial reports. The Australian government, as part of its ten year, but now five year, support package, had donated accounting software and trained provincial bookkeepers to use it, but still information from the provinces was often irregular and unreliable.

Because it was an Australian government donation, the software they were using was an Australian product, originally designed for small businesses. I gathered this was, in fact, the third attempt by Australia to introduce this particular accounting software in the Ministry of Health. Previous efforts had been abandoned during political upheavals or when the funding ran out. The success of the third attempt also seemed to be in doubt. Despite the new computers and software, regular, accurate and comparable reports from the provinces were still not forthcoming, and the Australian government’s funding was about to run out again.

**

The lack of data from the provinces did, at least, give me an excuse to visit some of the more distant parts of the country to find out for myself what they were doing.

I started by taking a Solomon Airways flight to Gizo, the second largest town, at the far end of the archipelago. The lady who made the booking assured me I would be flying on their ‘big plane’. The big plane turned out to be a twin-engine propeller aircraft – not, in my view, that big. It landed on a narrow dirt airstrip in the sea offshore from Gizo town and we finished the journey in a small open boat.  

The Gizo hospital was an old timber building with louvre windows standing on stilts on the muddy shoreline. Following a tsunami a few years earlier, sea water was now lapping underneath the building. A new hospital was in the process of being constructed, with Japanese government funding, a few hundred metres down the road – a tsunami-proof, multi-storey building of reinforced concrete costing US$70 million.

Many people were not at all happy about the plan for the new hospital. It would have lifts and airconditioning and windows that didn’t open. It would therefore require a regular supply of electricity, which would have to be generated using expensive, imported diesel fuel. Maintaining the equipment would also require technical expertise the country probably didn’t have. The operating costs of the building would soak up a significant part of the national health budget. This was one of the many things that had not yet been factored into budget planning.

Some people also pointed out that seventy million dollars would go a long way towards buying drugs and providing community health care, which they thought should be a higher priority than a new, high-tech hospital.

When I arrived at the old, low-tech hospital for my scheduled meetings, I found three well dressed young men lined up on a wooden bench in the reception area. They were British medical students who’d just arrived to volunteer at the hospital for a few weeks. They seemed frightfully posh and somewhat shocked by the conditions they found themselves in.

It turned out that the hospital almost always had a few medical students from the UK or from Australia working on two to four week postings, and there was always one Australian doctor seconded on rotation from St Vincent’s in Sydney.   

My first appointment was with the provincial health director who, like most regional public servants anywhere, had a large number of complaints about central office. His main problem at the moment was the late arrival of the budget funds allocated by the government which meant he’d had to re-allocate money meant for medical supplies to pay staff salaries.

Then I visited the accountant, who printed out the financial reports I needed, the director of nursing, who clarified questions about the number of staff and their salaries, and finally the hospital pharmacist. The supply of medicines was one of the most complex logistical issues in the ministry. Working out how to procure supplies that were affordable and available on time, and ensuring they were used before they passed their expiry date, was occupying the attention of several international experts in the ministry at the time.

I was hoping to get information about the cost of the drugs used by the hospital and the local clinics, but unfortunately the pharmacy didn’t have any computerised records. Information on pharmacy stocks and distribution was kept on slips of paper and index cards. It would be a major effort to compile a report on what had been received and what had been distributed. Apart from the inconvenience of this for my research, the lack of good recordkeeping meant it would be easy for supplies to go missing and perhaps end up on the black market.

**

I made two more visits to provinces and both times I was definitely not travelling in the ‘big plane’. I flew to Auki, the main town on the island of Malaita, in a single engine aircraft piloted by a young woman from Vanuatu. There were five other passengers, including the one sitting up front next to the pilot. Once I let go of my terror it was, in fact, a beautiful journey over coral reefs and green forested islands in the early morning sun.

We landed on a bumpy dirt runway cut into the tropical forest north of the town. The local director of nursing met me in his official vehicle and took me straight to a series of meetings and discussions at the local hospital, another run down timber building with peeling paint, not far from the airport. Once again I collected reports from the accountant, clarified the number of hospital staff, and visited the pharmacy. Here, as in Gizo, the records were also entirely on paper and it wasn’t possible get information on the value of drugs used and where they went. This pharmacist did, however, have a computer and was planning, one day, to computerise his records.

It was a short visit and I was back at the airstrip by late afternoon to board the return flight, this time quite prepared to relax and enjoy the stunning views.

My visit to Tulagi, 40 km across the water from Honiara, was something else again. There were no flights or scheduled ferries so I travelled in an open dinghy with an outboard motor, known to locals as an OBM. I met the boatman, Henry, on the beach in downtown Honiara at lunchtime. Before we set off, I had to provide cash to buy fuel for the journey. I waited by the boat while Henry went off to fill his jerry cans at the nearest diesel pump.

I clambered into the boat without getting my feet wet and sat in the front with my backpack as we sped across the water towards a smudge of land on the horizon. It was too noisy to make conversation. The wind blew my hair back and salt spray splashed my face. Now and then small fish flew into the air, their fins spread wide, like birds skimming across the water.

About an hour later we landed on another beach at Tulagi township and I waded ashore. Henry pointed me towards a faded fibro building behind some beachside trees, then pushed the boat back into the water to head back to Honiara.

I staggered across the sand, up to the building, opened a door and walked straight into a meeting of senior local officials. My hair was stiff with salt spray, my face was windblown and dry, and my shoes were wet and crusted with sand, but I took my place at the conference table and made my scheduled presentation about what I was doing there, trying my best to look professional.

It was by now late afternoon. I arranged meetings for the next day and was driven to my overnight accommodation in the newer of the available guest houses. Not a lot of tourists come this way so I was their only guest.

Before the sun disappeared, precisely at 6pm as it does in the tropics, I walked around the spread-out township. Until the second world war, Tulagi had been the capital of the British Solomon Islands and there were signs that it had been a thriving town with a considerable amount of industry. Now, however, the industrial buildings were abandoned and dilapidated.

I passed the local primary school and met a group of Australian Rotary volunteers who were there to build a new fence and install rainwater tanks. Next to the small Tulagi police station, with its peeling blue paint, a purpose built concrete block structure housed an ANZ automatic teller machine. Apart from this there was no bank on the island.

The next day I followed the familiar routine of meetings about staff numbers, financial data and pharmacy costs. As in other provinces, central government funds had been late to arrive and staff salary payments had therefore been delayed for more than a month. Salaries made up about 70 per cent of health expenditure. Most of what was left was used to buy fuel to travel around the islands and to run the generators to provide electricity.

At least in this province, the paper records of pharmacy transactions were good enough to allow me to work out how much was being spent on drugs.  

In the afternoon, I returned to the beach at the appointed time and met Henry for the OBM journey back to Honiara. The flying fish now came in large groups, launching themselves out of the water to escape a predator below the surface, sometimes landing in the boat. Henry briskly turfed them back into the sea. At one point on the journey the shiny grey humps of swimming dolphins followed the boat for a while.

Finally we returned to the beach in Honiara and I staggered across the sand and up to the road to find a taxi back to my hotel, exhausted after an hour in a noisy open boat with hot tropic air laced with diesel exhaust fumes blowing in my face.

**

After my provincial visits I arranged meetings with all the other organisations that had a role in the financing of health care in the Solomon Islands. They included the Japanese and Australian governments, the World Health Organisation, several UN agencies, the Global Fund for Malaria, TB and HIV/AIDs, and numerous other smaller organisations. Everywhere I looked I found foreigners propping up government services, like the Rotary team in Tulagi or the volunteer doctors in Gizo.  

Thanks mainly to donors like these, shoppers at the Honiara central market were bombarded every weekend with information about threats to their health and well being. Women with megaphones harangued the crowd with warnings and advice and gave out leaflets, badges and posters. Each week it was a different disease. One week diabetes, the next HIV/AIDs, or swine flu, or malaria. Banners strung across the main street promoted the benefits of using bed nets, regular hand washing and a healthy diet, or warning of the dangers of smoking, alcohol and fried food.

The delivery of these information leaflets, posters and awareness raising presentations to the community would have been one of the key outputs of various donor-funded health campaigns, to be reported back to the government or organisation that had put up the money. Unfortunately, the answer to the health problems of the Solomon Islands was not as simple as running an information campaign.

I also met with officials and advisers in the Solomon Islands Ministry of Finance, most whom turned out to be Australians on secondment from Canberra. They worked out of a very modern new building – a replacement for the one burnt down during the civil unrest. Their description of the state of public finance management in the government sounded very familiar. They mentioned all the usual developing country problems: unacquitted advances, unreconciled bank accounts, over-ambitious budget plans and un-coordinated Cabinet decisions.

 Arranging meetings with senior officials in the Ministry of Health proved more difficult than I’d expected because government executives and ministers were always travelling on donor-sponsored trips. The Permanent Secretary of the Health Ministry was on his way to a conference on malaria in Addis Ababa when I tried to make an appointment, having recently returned from a two week visit to Japan to sign the contract for the new Gizo hospital. At the same time, one of the Undersecretaries was on his way to Cuba to discuss their doctor training program, and the other one was preparing to go to Moscow for a meeting on road safety, which didn’t seem to me to be a high priority given that Solomon Islands has very few roads.

Not much happened in the Ministry while they were away. There was no one around to make decisions. This was a problem throughout the administration. At times it seemed as if there were no senior officials in the country at all.

It was similar at the provincial level. Staff were away from their posts for many weeks of the year attending training courses and meetings in Honiara or sometimes in Fiji or PNG or Australia. The training was no doubt useful, but often they were notified of the course at short notice giving little time to rearrange the roster or find temporary replacements.

It was difficult for government staff to say no to these invitations, partly because they feared offending the donors, but also because it meant free travel and accommodation as well as a daily expenses allowance. And what other opportunities are Solomon Islanders going to have to travel to these places?

As it happened, the planned trip to Moscow to talk about road safety was vetoed by the Prime Minister who decreed there would be no more overseas travel by government officials for the rest of the year. The Undersecretary told me he hadn’t really wanted to go to Moscow in November anyway.

**

The Honiara daily newspaper, the Solomon Star, was a trove of information on local events and political gossip. One Saturday, for example, spectators at a football match between teams from the islands of Guadalcanal and Malaita disagreed with a referee’s decision and set fire to the Solomon Islands Football Federation building, burning it to the ground. It was apparently the second time this had happened in recent years.

The newspaper also reported at length claims by the Minister for Health that he had been robbed of more than $200,000 in the main street of Honiara. The cash, which he said was donor money intended to be spent in his constituency, was stolen from his car at night while he was eating at a well known restaurant. The thief, allegedly, broke the car window and grabbed the bag of cash.

A letter writer in the Solomon Star pointed out, however, that Honiara’s main street at that time of night is quite a busy place, with many passers by and a fair number of private security guards on duty at nearby restaurants and businesses. It seemed strange then that no one saw or heard the thief smash the window and make off with the money. Moreover, the letter writer pointed out, this seemed to be the third time that such an unfortunate event had happened to this politician. So there was some doubt about whether the money had really been stolen, or whether it was, possibly, pocketed by the minister, or in fact had never existed in the first place and the theft story was just a way to explain to his constituents the lack of funds to pay for the village projects he’d promised.

Each elected representative in parliament had a fund of money available to them to spend on projects in their local constituency and there was very little scrutiny of what they did with it. This meant there was ample scope for kickbacks, inflated contracts and nepotism. Politicians were generally elected on the basis of what handouts they promised to deliver to their local area, rather than what they would do for the country as a whole. After each election, voters soon realised that the promises they’d been made were significantly larger than the money available in the constituency fund and very few politicians were re-elected.     

**

After several months of meetings and trawling through reports to find data on spending levels and costs, I was ready to submit my report on future budget requirements. It included graphs on trends in population and demand and projected levels of spending.

I identified several major costs that had not yet been taken into account in the budget. One was, obviously, the likely cost of operating the new Gizo hospital. Another was the future impact of all the new Cuban-trained doctors. In a few years time, if things went to plan, they would start returning to the Solomon Islands expecting to work as doctors. Who would pay their salaries? There were few opportunities to work in private practice so they would have to be employed by the government. They would also need clinics and nursing support and equipment and, of course, a government provided house.

Another section of the report considered where the money would come from. It revealed the extent to which the country was dependent on foreign donors. One graph showed a tidal wave of donor funding crashing onto the islands over the next three years, and then suddenly disappearing. Of course, the relevant donors would, probably, most likely, and hopefully, renew their generous commitments before the tidal wave passed, but there were no guarantees. It would depend not only on what happened in the Solomon Islands, but also on the policies of numerous domestic governments through their various political cycles, and the state of the global economy in three years time. And, despite donors’ commitments to consultation and cooperation with the elected government, in reality government ministers and senior officials had little say over what donor organisations did, or how they did it.

**

By the time I left the Solomons at the end of my assignment I had completely changed my ideas about the attractions of life in a tropical paradise. My naïve idea that it might be possible for people in picturesque island villages to continue to live their traditional way of life, without development and modern ideas, had been completely jettisoned.  

My work on the health care problems of the country had made me understand that the simple life of thatched roof huts on palm fringed beaches and self sufficient fishing and gardening are far from idyllic if you are, for example, woman about to give birth with no access to a health professional, or a child with malaria and no access to drugs.

The people who live on these tiny islands in the Pacific, or for that matter in remote mountain villages in Afghanistan, or anywhere poor or remote, want the same things everyone wants. Women want to survive giving birth and have a healthy baby, and parents want their children to grow up without dying from preventable diseases. And, despite their isolation, they are well aware that these things are possible.

But how are they going to be able to enjoy the same health care that’s available to their fellow citizens who live in cities and towns?

Religious charities and volunteer doctors and international donor funds do a lot of good, but they’re not a long term solution. Ultimately the national government needs to be able to provide health services to its people. And this means they need to be able to employ trained health professionals, and that requires an education system to train them, and a bureaucracy to manage them, and that, in turn, requires taxes and politicians. And all that, ultimately means development and modernisation and all the problems that brings.

So aid projects that help the government do its job effectively are just as important as donating money to buy drugs or build clinics if you want to save lives.

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