I knew I was going to love this job here,” says Anthony Lake, Unicef’s executive director, pointing at his heart beneath his suit jacket. “But,” he points to his head, “it is fascinating here too. There are no boring bits.”
Aid has always been heart-led. Charities tried to move donors by showing pictures of starving children. Donors sent money. Whether the money helped, nobody quite knew. The only thing in aid that was habitually measured was the input: the amounts donated. The output – lives saved or improved – almost never was.
Yet since Lake took over the United Nations’ children’s charity in 2010, the amiable American has watched the so-called “evidence-based revolution” in aid. Finally, academics, donors and even some aid agencies have begun measuring what works. Very slowly, development is becoming a science.
Arguments over aid used to be general. People such as Jeffrey Sachs said aid worked; others such as William Easterly said it didn’t. Lake, who was President Clinton’s national security adviser, sighs. “I think back to the macro-debates when I was in the White House. Absolutist views are almost by definition not grounded in reality.” Often aid does work, he says. More children are getting vaccines and clean water. Aids, malaria and measles are finally in retreat. Life expectancy is soaring. But, he adds, “Of course aid often fails.” Then the question becomes: which aid works?
Here Lake seems to be with the new “randomistas”, who say that to find what works in aid, you need to apply the sort of randomised control trials used in medicine. For instance: how to persuade teachers in rural India to turn up at school? Esther Duflo, the development economist, arranged for classrooms to have free cameras. Pay depended on how often teachers could show end-of-day photographs with their classes. Suddenly, more teachers showed up.
“What works” can be simple and cheap, says Lake. “A great contribution to the child survival revolution were things like oral rehydration salts. Jim Grant, my predecessor, used to walk around with a package of salts in his pocket to show how simple this was.” The sachets, which cost just cents each, have saved millions of children with diarrhoea from dying. On a macro level, too, Unicef has been measuring what works. Consequently, it’s now targeting the poorest families and countries. Lake explains: “By definition, the same immunisation programme where there’s lots of disease will save more children’s lives than where there’s less disease.” Anyway, he adds, focusing on the poorest is “right”.
But as we talk on about aid, he throws in a corrective: “All those who work in the international community on development tend to overstate the impact of what we’re doing. What’s far more important is the performance of governments.” Governments and markets, not aid agencies, have lifted hundreds of millions out of poverty since 2000. And in some countries that remain poor, governments have improved life nonetheless. When I ask for an example, Lake cites Bangladesh. Despite its “vigorous” politics, he says, rival parties usually come together on development. Bangladesh has dealt so well with problems such as open defecation – “which you never talk about in polite company, but which kills lots of children” – that it is now moving on to even tougher issues. Lake marvels: “The biggest killer of very young children in Bangladesh is now drowning.” Unicef is teaching them to swim.
You won’t see those dead or dying children in Unicef’s campaigns. In Africa’s Sahel, where a terrible famine is just starting, Unicef has broken old habits by not depicting the dying. First, says Lake, “It’s exploitative. Even children one day old have the same right to privacy that we would want if we were dying.” Moreover, though: showing those pictures doesn’t work. Lake says, “Yes, there’s a shock value to showing a child who’s about to die. God knows I’ve seen them on my travels, and I’m always shocked.” But eventually, he warns, “the shocking image no longer shocks. If you, over a generation and more, keep showing these images, then many simply say, ‘Well it’s happening again, I’ve been sending all this money and yet they still seem to be dying.’”
Lake’s own experiences have pointed him to a better way. In Chad recently he walked into a tent full of severely malnourished children. “And it was clear to me: a number of these children were going to be dead within a day or two. I stayed with them a while, and talked to their parents, and then I went to the next tent – which held the children who’d been in the first tent a week ago. They were still in a tough state, but were sitting up etcetera. I talked to the parents of one, and their little daughter’s name was Fatima, and I was inspired to do all I could for her in part because I was so damned curious to know – and I’ll never know – where Fatima was going to be 20 years from now.” Unicef now uses pictures of recovering children. Thanks to smart aid, more and more do recover.