'I know you like the back of my hand': biometric practices of humanitarian organisations in international aid

Humanitarian organisations are increasingly utilising biometric data. However, we know little about the extent and scope of this practice, as its benefits and risks have attracted all the attention so far. This paper explores the biometric practices of the United Nations Refugee Agency, the United Nations World Food Programme, the International Committee of the Red Cross, Médecins Sans Frontières, and World Vision International. The study analysed relevant documents published over the past two decades and 17 semi-structured interviews with humanitarian workers conducted between June 2021 and June 2022. The findings reveal that humanitarian organisations use diverse types and functions of biometric data for different services, collaborate with many actors, and employ various data protection measures. Ultimately, challenging the straightforward generalisations about the use of such data, the paper argues that variational applications of biometrics in the humanitarian context require case-by-case analysis, as each instance will likely produce a different outcome.

A Network Model Approach to International Aid

Decisions made by international aid donors regarding the allocation of their aid budgets to recipients can be mathematically modelled using network theory. The many countries and multilateral organisations providing developmental aid, mostly to developing countries, have numerous competing or conflicting interests, biases and motivations, often obscured by a lack of transparency and confused messaging. Using network theory, combined with other mathematical methods, these inter-connecting and inter-dependent variables are identified, revealing the complicated properties and dynamics of the international aid system. Statistical techniques are applied to the vast amount of available, open data to first understand the complexities and then identify the key variables, focusing principally on bilateral aid flows. These results are used to create a weighted network model which is subsequently adapted for use by a hypothetical aid recipient. By incorporating modern portfolio theory into this weighted network model and taking advantage of a donor's reasons for allocating their aid budgets to that recipient, a simulation is carried out treating the problem as an optimal investment portfolio of aid determinant 'assets' which illustrates how a recipient can maximise their aid receipts. Suggestions are also made for further uses and adaptations of this weighted network model.

Whose voice counts? Examining government-donor negotiations in the design of Ethiopia's large-scale education reforms for equitable learning

MOTIVATION

The Government of Ethiopia has a long-standing commitment to improving the quality of education. In recent years, this has shifted to include a more explicit focus on equity in learning outcomes. In this paper, we examine the education reform design process in the context of Ethiopia's political environment which is widely recognised as a strong developmental state.

PURPOSE

The article examines how federal, regional, and international donor actors negotiate their interests in relation to Ethiopia's national quality education reform programme, the General Education Quality Improvement Programme for Equity (GEQIP-E).

METHODS AND APPROACH

We conducted 81 semi-structured, key informant interviews with federal and regional government officials and international donors who were involved in the design of GEQIP-E.

FINDINGS

We find that federal government was able to leverage considerable political influence over high-level priorities and the framing of GEQIP-E. Large donors leveraged financial influence to exclude some specific priorities, while smaller donors were able to draw on social influence and technical expertise to include priorities aligned with their interests. Regional governments-which are responsible for policy implementation-were largely excluded from the reform design process.

POLICY IMPLICATIONS

Our analysis highlights the importance of recognizing and understanding different forms of influence in the dynamic process of negotiating reform between government and donors. It identifies that both government and donor voices counted in the process of negotiations, but in different ways and to varying degrees. Understanding how different actors draw on their relative political, financial, and social influence is vital for ensuring successful implementation and sustainability. Importantly, we identify that voices of local actors are left out.

Organization of funding for community-based HIV testing in Côte d'Ivoire: potentially counterproductive search for efficiency?

Since the early 2010s, the President's Emergency Plan for AIDS Relief (Pepfar) and the Global Fund to Fight AIDS, Tuberculosis and Malaria have stiffened their result-based management strategies. Disbursement conditions are increasingly demanding for funded NGOs (achievement of quantified objectives, frequent reporting, and monitoring of activities), and their remuneration depends on the results achieved. This article aims to analyze the effects of this strengthening of policies based on New Public Management on local implementation of activities, based on the example of community-based HIV testing. In three health districts of Côte d'Ivoire, in 2015 and 2016, we mapped the actors involved in community-based HIV testing and conducted semi-directive interviews with members of the community-based NGOs (n = 18). The funding of local HIV testing organizations is channeled through intermediary organizations according to a complex pyramid system. This, combined with cumbersome activity reporting and data validation, results in delays in the disbursement of funds and significantly reduces the actual time available to implement activities, i.e., to less than half the time planned for this purpose. This managerialization -of both Pepfar and the Global Fund - produces the counterproductive effects against which it was supposed to fight.

Vertical and horizontal equity of funding for malaria control: a global multisource funding analysis for 2006-2010

Background

International and domestic funding for malaria is critically important to achieve the Sustainable Development Goals. Its equitable distribution is key in ensuring that the available, scarce, resources are deployed efficiently for improved progress and a sustained response that enables eradication.

Methods

We used concentration curves and concentration indices to assess inequalities in malaria funding by different donors across countries, measuring both horizontal and vertical equity. Horizontal equity assesses whether funding is distributed in proportion to health needs, whereas vertical equity examines whether unequal economic needs are addressed by appropriately unequal funding. We computed the Health Inequity Index and the Kakwani Index to assess the former and the latter, respectively. We used data from the World Bank, Global Fund, Unicef, President’s Malaria Initiative and the Malaria Atlas Project to assess the distribution of funding against need for 94 countries. National gross domestic product per capita was used as a proxy for economic need and ‘population-at-risk’ for health need.

Findings

The level and direction of inequity varies across funding sources. Unicef and the President’s Malaria Initiative were the most horizontally inequitable (pro-poor). Inequity as shown by the Health Inequity Index for Unicef decreased from −0.40 (P<0.05) in 2006 to −0.25 (P<0.10) in 2008, and increased again to −0.58 (P<0.01) in 2009. For President’s Malaria Initiative, it increased from −0.19 (P>0.10) in 2006 to −0.38 (P<0.05) in 2008, and decreased to −0.36 (P<0.10) in 2010. Domestic funding was inequitable (pro-rich) with inequity increasing from 0.28 (P<0.01) in 2006 to 0.39 (P<0.01) in 2009, and then decreasing to 0.22 (P<0.10) in 2010. Funding from the World Bank and the Global Fund was distributed proportionally according to need. In terms of vertical inequity, all sources were progressive: Unicef and the President’s Malaria Initiative were the most progressive with the Kakwani Indices ranging from −0.97 (P<0.01) to −1.29 (P<0.01), and −0.90 (P<0.01) to −1.10 (P<0.01), respectively.

Conclusion

Our results suggest that external funding of malaria treatment tends to be allocated to countries with higher health and economic need but not in proportion to their relative health need and income when compared to other countries. While malaria eradication might require funders to disproportionally allocate funding that goes beyond (financial and health) need, our analysis highlights that funders might potentially be targeting in excess certain countries. Regular assessments of need and greater coordination among donors are necessary for equitable resource allocation, to improve and sustain progress with malaria control and elimination.

The impact of global health initiatives on the health system in Angola

We assessed the impact of global health initiatives (GHIs) on the health care system of Angola, as a contribution to documenting how GHIs, such as the Global Fund, GAVI and PEPFAR, influence the planning and delivery of health services in low-income countries and how national systems respond. We collected the views of national and sub-national key informants through 42 semi-structured interviews between April 2009 and May 2011 (12 at the national level and 30 at the sub-national level). We used a snowball technique to identify respondents from government, donors and non-governmental organisations. GHIs stimulated the formulation of a health policy and of plans and strategies, but the country has yet to decide on its priorities for health. At the regional level, managers lack knowledge of how GHIs' function, but they assess the effects of external funds as positive as they increased training opportunities, and augment the number of workers engaged in HIV or other specific disease programmes. However, GHIs did not address the challenge of attraction and retention of qualified personnel in provinces. Since Angola is not entirely dependent on external funding, national strategic programmes and the interventions of GHIs co-habit well, in contrast to countries such as Mozambique, which heavily depend on external aid.

The socioeconomic impact of international aid: a qualitative study of healthcare recovery in post-earthquake Haiti and implications for future disaster relief

We assessed healthcare provider perspectives of international aid four years after the Haiti Earthquake to better understand the impact of aid on the Haitian healthcare system and learn best practices for recovery in future disaster contexts. We conducted 22 semi-structured interviews with the directors of local, collaborative, and aid-funded healthcare facilities in Leogane, Haiti. We coded and analysed the interviews using an iterative method based on a grounded theory approach of data analysis. Healthcare providers identified positive aspects of aid, including acute emergency relief, long-term improved healthcare access, and increased ease of referrals for low-income patients. However, they also identified negative impacts of international aid, including episodes of poor quality care, internal brain drain, competition across facilities, decrease in patient flow to local facilities, and emigration of Haitian doctors to abroad. As Haiti continues to recover, it is imperative for aid institutions and local healthcare facilities to develop a more collaborative relationship to transition acute relief to sustainable capacity building. In future disaster contexts, aid institutions should specifically utilise quality of care metrics, NGO Codes of Conduct, Master Health Facility Lists, and sliding scale payment systems to improve disaster response.

Non-Communicable Chronic Diseases: Winning on Facts but Losing on Passion

Abstract-For the past ten years, there has been an extensive analytical effort attempting to convince policy makers to invest in the prevention and treatment of non-communicable chronic diseases (NCDs) in low- and middle-income countries. From an analytical perspective, it has been an impressive decade of data gathering and presentations culminating in the United Nations high-level meeting on NCDs in September 2011. On the other hand, funding for NCDs has remained at very low levels compared to the burden of disease associated with NCDs. An important question, therefore, becomes why has all this important analytical work so far been unable to generate significantly more additional funding for NCDs? There are many possible explanations for the lack of appreciable additional funding, but perhaps the most important reason is a lack of passion or grass roots advocacy for preventing and treating NCDs by the general public. Until the politicians and policy makers see some urgency from the general public, the funding situation is unlikely to fundamentally change. However, there are many different actions that can be taken by researchers and funders while the funding levels remain low. In addition, many highly cost effective programs should be highlighted.

Funding for malaria control 2006-2010: a comprehensive global assessment

BACKGROUND

The last decade has seen a dramatic increase in international and domestic funding for malaria control, coupled with important declines in malaria incidence and mortality in some regions of the world. As the ongoing climate of financial uncertainty places strains on investment in global health, there is an increasing need to audit the origin, recipients and geographical distribution of funding for malaria control relative to populations at risk of the disease.

METHODS

A comprehensive review of malaria control funding from international donors, bilateral sources and national governments was undertaken to reconstruct total funding by country for each year 2006 to 2010. Regions at risk from Plasmodium falciparum and/or Plasmodium vivax transmission were identified using global risk maps for 2010 and funding was assessed relative to populations at risk. Those nations with unequal funding relative to a regional average were identified and potential explanations highlighted, such as differences in national policies, government inaction or donor neglect.

RESULTS

US$8.9 billion was disbursed for malaria control and elimination programmes over the study period. Africa had the largest levels of funding per capita-at-risk, with most nations supported primarily by international aid. Countries of the Americas, in contrast, were supported typically through national government funding. Disbursements and government funding in Asia were far lower with a large variation in funding patterns. Nations with relatively high and low levels of funding are discussed.

CONCLUSIONS

Global funding for malaria control is substantially less than required. Inequity in funding is pronounced in some regions particularly when considering the distinct goals of malaria control and malaria elimination. Efforts to sustain and increase international investment in malaria control should be informed by evidence-based assessment of funding equity.