Working in Sierra Leone’s Ministry of Health and Sanitation uncovered an underlying prejudice among the white expatriate development community. Until the development sector deals with this problem, can the sort of relationship with governments needed for effective partnerships really be created?
Last week I went to a talk in Oxford about Sierra Leone’s Ebola emergency response. It was a presentation of a new book, Getting to zero: a doctor and a diplomat on the Ebola frontline.
The first question from a member of the audience made me mad.
The question was in reference to Kerry Town Ebola treatment centre, which was built by the British Government for around $80m during the emergency response and, a year later, mainly inhabited by stray dogs and goats.
To paraphrase the audience member, they said ‘while it is not very politically correct, is the lack of maintenance due to the inherent inability of Africans to maintain infrastructure?’ I am unsure I have captured the exact phrasing, but the sentiment was clear.
First of all, the question is racist. Not just politically incorrect, but racist. Any mention of inherent variation of abilities or tendencies due to race is racist. Just asking it plants a seed that, as a society (British, in my case), we seem unable to eradicate.
But the issue is far larger than one racist question from an Oxford audience member. Indeed, such attitudes present themselves in many and if not all industries, including the international development sector. Throughout my time working in Sierra Leone’s Ministry of Health and Sanitation, from 2011 to 2014, there existed a common underlying prejudice among the white expatriate development community.
These prejudices presented themselves in the form of jokes about stupid things done by Sierra Leonean colleagues, stories about crazy policy and implementation scenarios, the desire (and sense of entitlement) to bypass hierarchy and go straight to the relevant minister, the self-confidence in our own first impressions of ‘what needed to be done’. These were all manifestations of the underlying sentiment that ‘I am better able to manage this problem than you.’
But why? Based on what?
For context, in the years leading up to Sierra Leone’s Ebola outbreak the government had about $600m in domestic revenue a year to spend. With a population of about six million people, this left $100 per person to cover agriculture, education, water, electricity, the police, the army, the health system and much more. About $8 to $12 per person per year went on health. Given this, it would be absolutely mad for the government to invest in the maintenance of an $80m hospital.
The same can be said, unfortunately, for a lot of large infrastructure projects, which have often turned to ruins, related in this case to the practical unaffordability of the hospital’s maintenance.
Poor outcomes such as these may be construed by inexperienced and ignorant fresh-faced expats (such as myself at the time) as a Sierra Leonean inability to manage, implement or maintain. This is an echo of that ‘inherent inability of Africans’ sentiment I heard from the audience member. There is a fine line, if any, between the two.
Like anywhere, in Sierra Leone you will find some corrupt people, some with upmost integrity. Some geniuses, some idiots. Some logistical and planning masterminds, some chaotic last-minute scramblers. You will find people who will sacrifice all to help another, others who are out for no more than a day’s work. And, of course, the boundaries are always blurred.
True, these traits may manifest themselves differently in different contexts, and it is important for expats to try and understand this in their new environments. But I think there may be a tendency to couple an inflated sense of personal ability with frustration at local outcomes and, without even realising it, slip into generalised racist prejudices — ‘me and my expat friends are more capable than my local colleagues.’ In this way racism festers and grows.
Until the development sector can deal with this problem, I don’t see how it can nurture genuinely trusting and respectful relationships with the Sierra Leonean (or any other) government: the sort of relationship essential to a working development partnership.
Local counterparts see this prejudice. It infuriates those local geniuses, logistical masterminds and selfless souls when the international development community decides to place a young and inexperienced European statistician as a technical adviser to an agricultural community outreach programme, who may then joke with their friends about the ridiculousness of Sierra Leonean agricultural implementation, who then advises senior agricultural officers with the luxury of the minister’s ear (an only slightly hypothetical example…).
Never will those young expats actually have to deliver what a Sierra Leonean has to deliver. Never will they have to manage the implementation of million-dollar (yet still under-funded) programmes within the family, community, work and social structures of those who earn between $1 and $10 per day.
This is absolutely not to excuse corruption and poor management, which are real factors. Indeed, to accept such things under the T.I.A (This Is Africa) banner is just another manifestation of a racist prejudice that I found to be common within both expat and Sierra Leonean communities.
If you want to contemplate a Sierra Leonean’s ability to maintain something, look at what is maintained with the minuscule funds available: between 2011 and 2014 Sierra Leone’s public health system consisted of between 7,000 and 9,000 health workers, between 700 and 900 peripheral health units, around 30 secondary hospitals and three or four tertiary hospitals. These were maintained with a budget of about $10 per person per year as collected by the government itself. While supplemented by donors, it is the only money the government can rely on and plan for in the long-term.
At the individual level, think about the skill it takes to maintain an over-crowed panbodi house (made from corrugated iron) through the rainy season. Think about what it takes to maintain a 15-year-old Nissan Sunny while running a taxi all day every day over pothole-covered roads. For those who have become wealthy, think about what it takes to maintain your community in a ‘cotton tree culture’ (where those who have are expected to provide shade for those who have not).
What could you do with $10 per person in Sierra Leone? Personally, I would struggle to provide a week’s dinner, let alone a whole public health system. I doubt there is anyone on this planet who could reasonably maintain Kerry Town Ebola treatment centre within this sort of budget. If there is, however, I’d bet it’d be a Sierra Leonean.
Alex Jones worked in Sierra Leone’s Ministry of Health and Sanitation between 2011 and 2014, where he focused on national health accounts, performance based financing and social health insurance scheme design. He previously studied Philosophy and Economics at LSE and Health Economics at the University of York. He currently works for Public Health England.
The views expressed in this post are those of the author and in no way reflect those of the Africa at LSE blog, the Firoz Lalji Centre for Africa or the London School of Economics and Political Science.