The Idealist

by Nina Munk

  Flanked by three military police escorts on motorcycles, STATECAR 10 swerved into the oncoming lane and, with a screech of the tires, roared past the traffic jam, arriving a few minutes later at the Kilimanjaro Hotel Kempinski. The car door opened, and Sachs, ignoring the postcard view of the Indian Ocean, hurried up the red carpet and across the marble floor of the vast lobby barely in time for his first appointment: a meeting with John Murray McIntire, the World Bank’s country director for Tanzania, Uganda, and Burundi.

  “I know what I’m talking about here, Jim,” said Sachs, not wasting a second on small talk. “There’s no reason, not a reason in the world, not to cover more people with bed nets.”

  “Look,” replied McIntire, “this government’s getting five to six hundred million dollars from us. Two or three hundred million of that is untied budget support, plus more from the donors. So maybe in total there’ll be five hundred million in untied budget support. They can spend that on anything they want.”

  “I’m talking about advice here, Jim,” Sachs told him. “You have a responsibility to give the country good advice. The current recommendations are retrograde and completely indefensible. I’d like the World Bank to lead the discussion, not just go along with the donors. Christian Lengeler may be a good malariologist, but he’s a bad economist. He can go to hell! I’m a good economist!”

  McIntire leaned back in his chair casually and crossed his legs. He looked the way a World Bank director is supposed to look. Maybe it was the tasseled loafers. Or the fact that he was wearing a blue blazer with khakis, and a white dress shirt monogrammed on the cuff (JMM). “You need to calm down, Jeff,” McIntire advised. “Everyone’s committed to the same goal here.”

  “This is about life and death—that’s why I get heated about it!” Sachs told him. “This is just outrageous, Jim!”

  “It’s John, not Jim.”

  “From an economic point of view, John, I think the whole thing is utterly preposterous.”

  “You’re spending an hour with the president today,” McIntire said, trying to wriggle off the hook. “If he wants to chart another course, he should just say, ‘This is what we’d like to do.’ He doesn’t have to follow the donors’ advice.”

  Every year Tanzania is sustained by more than $2 billion in foreign aid. Nearly 40 percent of the government’s entire budget is underwritten by foreign aid. Without its international donors, the country would collapse in a heap. How likely was it that the president of Tanzania would disagree with the donors’ advice about bed nets or anything else?

  It was the great statesman Julius Nyerere, Tanzania’s first president after independence, who noted the “neocolonial” relationship between his country and its donors. “The English have a proverb which says: ‘He who pays the piper calls the tune,’ ” he wrote in his seminal Arusha Declaration of 1967, which outlined his vision for Tanzania. “How can we depend upon foreign governments and companies for the major part of our development without giving those governments and countries a great part of our freedom to act as we please? The truth is that we cannot.” How independent can an impoverished country be?

  Sachs moved on. “Your job—and I mean this only with respect,” he said impatiently, “—is to advise this country, not to hunker down!”

  “We’re not hunkering down,” McIntire objected.

  “Lengeler is giving advice, and it’s bad advice,” Sachs insisted. “My advice is much better. And your advice would be too. I’d love nothing more than to have the World Bank lead on this issue. There’s nothing mysterious about how to make great progress on malaria. All I want is for you to say that poor people will die unless we spend more! In the end it comes down to saying, ‘Let’s spend one day’s Pentagon spending to cover all sleeping sites’!”

  “We agree, Jeff,” said McIntire. “It’s not rocket science. But when people speak of restraint, they are not complicit in human suffering—they just recognize that the U.S. government would rather spend money on bombers.”

  “It’s complacency,” Sachs answered firmly. “The donors are just sitting in the comfort zone. This is how it’s been for years: complacency and fear. I can’t see any reason why the world can’t get its shit together to cover three hundred million sleeping sites in Africa! It’s less than a day of Pentagon spending! It’s chicken feed!”

  Leaving the Kilimanjaro Hotel Kempinski, Sachs moved on to the Swedish embassy, where he was scheduled to address a group of foreign aid donors. By the time he arrived, every seat in the room was taken, and more people kept walking in.

  “I know we’ve had a lot of e-mail exchanges in the last few days,” said Sachs agreeably. He’d calmed down since his meeting with McIntire. “But I’d like to speak briefly and more broadly today about how to achieve our goals in Tanzania.”

  There was nothing brief about Sachs’s speech. There never is. Using his Millennium Villages Project as a case in point, he lectured the donors on ways to achieve the goal of ending poverty in Tanzania: Doubling or tripling agricultural outputs. Building a basic health care system. Providing universal primary education. Ensuring access to safe water. Generating electricity. Building roads. Constructing manufacturing centers. Establishing export markets. Attracting tourists. On and on he went, listing one intervention after another—interventions that would, in his opinion, “easily” lead to double-digit growth rates.

  Finally Sachs came to the vexed subject of bed nets; that’s what the donors had come to hear. “With mass distribution of bed nets we’ll break transmission.… The economics are absolutely straightforward.… I’ve recommended mass distribution for five years now.… This is the lowest-hanging fruit on the planet.… This is something that should be done. So what’s the problem?” he said. “This is about people’s lives! This is urgent!”

  Sachs’s forehead was damp with perspiration. “Are there any questions?” he asked. Not one. “Any comments?” Nothing. Fifteen seconds, thirty seconds, one minute.

  Finally, someone spoke. It was Pamela White, head of USAID for Tanzania. “I don’t want to argue with you, Jeff,” she said disdainfully, “because I don’t want to be called ignorant or unprofessional. I have worked in Africa for thirty years. My colleagues combined have worked in the field for one hundred plus years. We don’t like your tone. We don’t like you preaching to us. We are not your students. We do not work for you.”

  The meeting was over. Sachs stood up, pulled his tattered JanSport backpack over one shoulder, and walked out of the Swedish embassy. It was a beautiful day in Dar es Salaam. A light breeze was coming off the Indian Ocean. He took a deep breath of the salt air. “Sometimes,” he said to no one in particular, “I wonder why I need a Ph.D. for this.”

  It was time for Sachs’s meeting with Jakaya Mrisho Kikwete, the president of Tanzania. As he approached State House, he quickened his pace. Anyone else might have been discouraged by now, but not Sachs—he knew what had to be done. Taking matters into his own hands, he would lobby the president of Tanzania directly.

  “My basic belief, my very strong belief,” he said to the president, “is that Tanzania is the best-placed country in all sub-Saharan Africa to make a great breakthrough right now—and I’d like to do whatever I can to help you.”

  “I appreciate that,” the president said sincerely, leading Sachs through the Moorish archways of State House and into the formal drawing room.

  “It seems to me, from many points of view, Mr. President,” continued Sachs, “from governance, from the peace in the country, from the unity in the country, from the point of view of your resource base, your energy resources, your touristic resources, your agricultural resources, your seaport, your gateway to East Africa, your coastline—when I add it all up, it seems to me you’ve got all the makings of becoming Africa’s first emerging market.”

  Kikwete settled into an oversize mahogany armchair fitted out with burgundy silk-taffeta pillows. He wore a well-cut khaki suit with fashionable Chelsea boots and a black shirt open at the coll
ar. Behind him, standing at attention, were two guards in red ceremonial uniforms with gold tassels.

  By most measures, his country is a wreck. Nothing really works. There are few roads and even fewer doctors. Electric power is always in short supply. People are wretchedly poor. The average annual income is $1,510 per person. Nearly nine in every ten Tanzanians live on less than two dollars a day.

  Then again, progress is relative in Africa, and compared to its neighbors, Tanzania is a success. There was good reason for Sachs to be hopeful about the country’s future. It’s peaceful and not entirely corrupt—less corrupt than Russia, for example, or than its neighbors Kenya and Uganda. The economy, which had grown at an average of 6.7 percent between 2000 and 2006, was doing well: in 2007 it was expected to grow by 7 percent.

  Sachs was well along in his presentation. “I was just in Kenya, and you know they gave out three point four million nets,” he informed the president strategically, taking full advantage of Tanzania’s long-standing rivalry with its northern neighbor. “Keep in mind, Mr. President, that in four years you’ve only gotten out as many nets as Kenya did in just two weeks. And in Kenya, they’re now asking for the balance of the nets they need so they can go back, not just to cover children and pregnant mothers, but to cover every sleeping site in the country. This is what I’d like to happen in Tanzania.”

  “How did Kenya do it?” asked Kikwete. He was paying close attention.

  “Kenya just asked the donors,” answered Sachs, making it all sound effortless. “Kenya said, ‘We want to do mass distribution. We want to give them out.’ And the donors said ‘Fine.’ They just said, ‘Fine.’ So all you have to do is say you want to do it here.”

  “Really?”

  “Really,” replied Sachs. “We had meetings today with the various development partners, and after a lot of e-mails in the last couple of weeks, they’re now all saying, ‘Whatever the government wants to do, we’re ready.’ ”

  “Are they really?” repeated Kikwete.

  “Well, no one publicly said, ‘We oppose this,’ ” Sachs hedged, not wanting to stretch the truth to its limit. “They don’t dare. All you have to do is ask for the nets. That’s my guess. Now, it may be in the end, you know, disaster could strike, and in the end they turn you down. I don’t deny the possibility.”

  “So how do we do it?”

  “If it concurs with you,” said Sachs, “I think all that’s needed is a clear statement that says the government of Tanzania would like to move to a mass distribution based on the principle that each sleeping site in a malaria-transmission region should be protected by a long-lasting insecticide net—and that you would like to work with the development partners, the donors, to facilitate this approach on an expedited basis. That to me would be the start, just that statement.”

  “Are you sure?”

  “Absolutely,” Sachs assured the president. “It’s common sense. The donors know, scientifically, that they can’t justify their position.”

  “Well, common sense is not the issue,” said Kikwete, smiling. “It’s subjectivism.”

  Kikwete is no fool. He may depend on the donors for foreign aid, but he also knows how the game is played. He’s intelligent, charismatic, and enormously popular. (He was elected president in 2005 with 80 percent of the vote.) His English is flawless. After graduating with a degree in economics from the University of Dar es Salaam and rising to the rank of lieutenant colonel in Tanzania’s military, he spent a decade as the country’s minister of foreign affairs. As president, he continues to woo foreign investors and donors by embracing free-market capitalism.

  Kikwete has not only received a lot of foreign aid, but he’s received it in the form of “untied” or “direct” budget support. Untied support is a sign of the donors’ trust in him; instead of funding specific one-off development projects in Tanzania, they’re willing to contribute directly to the country’s general budget. Officially, direct budget support is unconditional, no strings attached. In practice, though, as soon as Kikwete antagonizes his donors by spending their money in ways they don’t approve of, they’ll withdraw their direct support.

  “Won’t they be angry?” Kikwete asked, referring to the donors. “The thing is, they have the money, and they decide what is best for us.”

  “Angry? What angry?” replied Sachs, in pretended disbelief. “You’re going to end malaria! You’ll make heroes out of them! Believe me, they’re on a failed course right now. If you push through a mass distribution of nets, you’ll make heroes out of them.”

  Kikwete laughed. He liked Jeffrey Sachs who, by hook or crook, wound up getting exactly what he wanted: insecticide-treated bed nets for all of Tanzania.

  Less than one month after Sachs left Tanzania, the World Health Organization issued official guidelines calling for the mass distribution of “free or highly subsidized” insecticide-treated mosquito nets to all Africans at risk for malaria. Everyone in the business was convinced that Sachs was behind the move. He probably was.

  Next came a major announcement by UN secretary-general Ban Ki-moon calling on member states to embrace the “bold but achievable” goal of providing universal coverage of mosquito nets across Africa by the end of 2010. The same day Kikwete himself, in his role as chairman of the African Union, issued a press release: “On behalf of the people, leaders and governments of Africa, I welcome and support the Secretary General’s call for action. Africa seeks—and actually deserves—universal coverage of malaria control interventions, with access for all.”

  Not long afterwards a $200 million grant came through. Funded largely by the Global Fund and the President’s Malaria Initiative, the grant would cover all of Tanzania with more than 18 million long-lasting insecticidal mosquito nets. Even Christian Lengeler was impressed. Mind-boggling is the word he used to describe the size of the grant. “None of us could have imagined that one country could get two hundred million dollars for a single intervention.”

  In 2008 Sachs’s good friend the philanthropist Ray Chambers, cofounder of the advocacy group Malaria No More, was named the UN’s Special Envoy for Malaria. His mission was to mobilize the funds and necessary tools to distribute a staggering 300 million bed nets across sub-Saharan Africa by the end of 2010, the stated objective being to end all deaths from malaria by 2015.

  Let’s say that universal coverage of bed nets is achieved, and that as a result, the rate of malaria transmission plummets. After four or five years, insecticidal long-lasting bed nets start to disintegrate. Unless they’re replaced, transmission rates in Africa will start rising. How likely is it that in four or five years, Africans themselves will be able to afford new bed nets? Is it realistic to assume that, when the time comes, groups like Malaria No More or the Global Fund can summon up the resources and enthusiasm to roll out another campaign for universal coverage?

  The more his ideas about universal coverage were challenged, the more short-tempered Sachs became. The endless back and forth, the equivocating, the calls for more studies and research and reports, the delays—that’s precisely why nothing got done in the field of development! “Believe me,” he snapped, “it’s over. The debate is over. It’s completely in the past. We’re in the implementation stage now.”

  Part Four

  I know that if you spend enough money on each person in a village, you will change their lives. If you put in enough resources—enough mzungu, foreigners, technical assistance, and money—lives change. I know that.… The problem is, when you walk away, what happens?

  —Simon Bland

  Chapter 10

  David Siriri

  Henry Morton Stanley referred to Uganda as the “pearl of Africa.” Winston Churchill called it a “fairy tale”: “Uganda is from end to end one beautiful garden, where the staple food of the people grows almost without labour, and where almost everything else can be grown better and easier than anywhere else,” he rhapsodized in My African Journey.

  Cotton grows everywhere. Rubber, fibre, hemp, cin
namon, cocoa, coffee, tea, coca, vanilla, oranges, lemons, pineapples are natural or thrive in introduction. As for our English garden products, brought in contact with the surface of Uganda they simply give one wild bound of efflorescence or fruition and break their hearts for joy. Does it not sound a paradise on earth?

  By the time of independence in 1962, any ambitious Ugandan wanted to get as far away as possible from the efflorescent land. In their eyes, there was nothing romantic about subsistence farming. With each generation, their shambas, their plots of land, had become smaller and less fertile, until people could barely grow enough food to stay alive. Now, instead of tilling the land, Ugandans wanted an African version of industrialized Europe. They wanted to wear a suit and tie and carry a fine leather briefcase.

  David Siriri’s parents belonged to Uganda’s fast-growing, post-independence middle class. They married in 1968; two years later, on December 14, 1970, their son David was born in the eastern town of Tororo, just a few miles from the Kenyan border. It was a time of hope: the country appeared to be at peace, the economy was one of the fastest growing in sub-Saharan Africa, and all across the nation young people were leaving the countryside to seek their fortunes in town.

  Siriri’s father was a mathematics teacher at the Kisoko Boys Primary School, just west of Tororo. His mother was a midwife at the local hospital. They weren’t rich, but they could envision a promising future for their children. Everything in Uganda was better than it had been. Instead of the mud-and-thatched-grass huts they’d grown up in, Siriri’s parents built themselves a three-bedroom “semipermanent” house with a tin roof. Siriri’s father was his parents’ only son; as a result, he inherited all twenty acres of his father’s land, on which the Siriris now grew millet, sorghum, cassava, soybeans, sweet potatoes, kidney beans—more than enough to feed their eight children. As well, they cultivated cotton, a cash crop introduced to Uganda by the colonial government to supply Britain’s textile industry.