A review of THE COMING PLAGUE: NEWLY EMERGING DISEASES IN A WORLD OUT OF BALANCE by Laurie Garrett, published in 1994. CHAPTER 7: N’ZARA: LASSA, EBOLA, AND THE DEVELOPING WORLD’S ECONOMIC AND SOCIAL POLICIES
Usually ignored were community-based projects
From both sides of the Iron Curtain, donors’ monetary contributions to poor nations were all too often linked to prestigious showpieces: hydroelectric dams, international airports, university complexes, tertiary care hospitals. Usually ignored were community-based projects, such as schools, medical clinics, skills training programs, or public health campaigns. Worse yet, donors preferred one-shot investments, and disappeared for the long-haul maintenance of their high-profile efforts; even the dams, airports, and massive construction projects soon took on a shoddy, potentially dangerous reality under their previously polished veneers. Lacking the foreign exchange to purchase replacement parts, hire expertise, or carry out routine maintenance, the poor countries had no choice but to let cracks go unchecked in their dams, watch helplessly as the tarmacs of their runways deteriorated, and use staircases when the elevators of their fancy office buildings broke down. Over a third of typical developing country budget was eaten up by recurrent costs, while donors insisted on funding only new, prestigious programs. Nongovernmental investment in developing countries came exclusively from the capitalist and social democratic states of North America and Europe, and was heavily targeted toward acquisition of vital resources. In Africa, in 1977, 56% of U.S. private investment was in petroleum, 26% in mining, and 6% in manufacturing.
They represented more a force of opposition than an alternative scheme for development
From the socialist and nationalist movements and intellectual circles of South America and Africa emerged the dependency theory of development. Overall, the dependency theorists provided cogent criticisms of Western modernization strategies and investment policies, avoided issues related to Soviet activities, and had no consensus on an alternative approach to raising the standards of living and health of the people of the Third World. They represented more a force of opposition than an alternative scheme for development.
The hospital becomes a drain rather than a boon to the society
Most of these critics (notably such intellectuals as André Gunder Frank, Theotonio dos Santos, Fernando Henrique Cardoso, and Enzo Faletto) argued that acceptance of loans and aid from multinational corporations and lending agencies led to cycles of ever-greater dependency and debt. For example, the poor country that wishes to build a hospital turns to a wealthy nation for donations and loans. Once granted, the hospital’s construction leads to a new dependency on Western-style medicine, drugs, and machines. Purchasing replacement parts for American X-ray machines or French autoclaves exhausts the country’s small foreign exchange resources. Eventually the hospital becomes a drain rather than a boon to the society, adding a budget line to the Ministry of Health’s already overdrawn accounts.
A lose-lose situation
The dependency theorists argued that poor nations lost out in two ways: they were compelled to purchase all equipment and expertise from the richer countries, and whatever products they, in turn, produced had to be sold back to those same wealthy-nation interests at prices set by the purchasers. This, they insisted, represented a lose-lose situation. By the late 1970s even Western investors were beginning to recognize that modernization wouldn’t inevitably bring 20th century European standards of living and health to the Third World. In the early 1970s the U.S. Agency for International Development had focused on gross national product (GNP) growth as the crucial measure of success for Third World countries. By 1997 the agency’s administrator, John J. Gilligan, was compelled to reverse that policy.