Sometimes, I must sheepishly admit, I sneak a glance at LinkedIn. It is a minor addiction. Similar, but not quite on par with the people who cannot look away from a motorway pile-up.
For the uninitiated, LinkedIn is the platform where the world’s most accomplished, visionary, battle-hardened professionals, all blessed with exceptional leadership qualities and a passion for driving impact, tirelessly advance their careers by informing humanity which celebrity they happened to run into while going about their daily business.
One recent post from UNICEF Uganda caught my eye: “Big Boost for Children in Uganda.” The US Government had provided USD 5.2 million through the East and Southern Africa Humanitarian Fund (ESAHF), managed by the United Nations Office for the Coordination of Humanitarian Affairs (OCHA), to strengthen efforts against child malnutrition in Karamoja.
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| UNICEF RD in Karamoja |
Under the sub-coordination of the UN Resident Coordinator, UNICEF, World Food Programme, and United Nations High Commissioner for Refugees were hard at work sustaining essential services for vulnerable children. Screening had begun using MUAC tapes. The UNICEF Regional Director had visited to personally feed therapeutic food to a child. All presented in the familiar humanitarian dialect that no longer causes my pulse to quicken.
What stopped me mid-scroll, however, was a comment from our friend Roger Pearson, who mentioned that he had coordinated a similar campaign in the same Karamoja forty years ago. Back then, they managed to avert famine.
Forty years later, Uganda has better roads, greater market access, more infrastructure, more trading centres, smartphones and vastly more trained health personnel. Yet here we are again: emergency malnutrition screenings, therapeutic feeding, donor appeals, and international agencies parachuting in with measuring tapes as though history had stood still.
A quick search online showed that UNICEF has been conducting emergency malnutrition screenings in Karamoja repeatedly over the years, including in 2022. For decades, UNICEF has received funding for nutrition and emergency interventions. My mind drifted back twenty years, when I counted ninety-five (!) separate UNICEF projects operating simultaneously in Uganda.
The latest UNICEF country programme allocates 54 percent of its Regular Resources, roughly USD 39 million, to “Programme Effectiveness,” which is about twice the amount allocated to Health and Nutrition. Previous years’ expenditure figures themselves are difficult to untangle, as the UNICEF Transparency Portal has become remarkably opaque. Even figures appearing on the same page seem not to agree with one another.
But the story becomes even harder to reconcile.
Uganda has received roughly USD 2 billion in aid annually for well over a decade. Every donor, agency, coordinator, planner and workshop facilitator solemnly assures us that the focus is always on “the most vulnerable.” Yet after forty years of interventions, reforms, appeals, capacity-building exercises, strategic frameworks and PowerPoint presentations, it remains necessary for foreign agencies to instruct Ugandan health workers to begin screening children in Karamoja for malnutrition.
Something in this long story of crisis, development, aid, and perpetual reform simply does not add up.
Einstein is often credited with saying that insanity is doing the same thing repeatedly while expecting different results. Whether or not he actually said it, donors seem to be noticing as well.
Two more points:
ReplyDelete1. Both the Karamojong and Yoweri Museveni are cattle farmers or herders. Museveni describes himself as rich, while Karamojong children survive from plumpy nuts handed to them by the foreign aid industry.
2. According to its 2025 annual report, UNICEF Uganda continues to lobby the government to spend one million US dollars annually on therapeutic food. Is it possible that the presence of aid organizations undermines the government's accountability to prevent Ugandan children from dying of malnutrition?
My dear friend Detlef, WE (UNICEF) are the vulnerable ones, we need the support every year to attempt to remain relevant, or just remain!!!
ReplyDeleteBrilliant. Like the UNRCO annual report and UNINFO (UNRC version of our RAM) - I have always failed to grasp who is the audience for LINKEDIN? Maybe my tone deaf sense of reporting and self promotion is why I rose so slowly ( I call it early plateauing). I was once visited by UNICEF Uganda staff under direction of the RD to help us nail down our district focus in Tanzania. I was told that direct funding of districts solved all DCT problems and had more impact. That was around 23 years ago? We then did the evaluation of our own district program- only to find no difference between places we funded and did not fund- as far as outcomes for children. Could it be I wasted 32 years of my life pounding my brain to measure impact? When I could have been on LinkedIn living the life?
ReplyDeleteSomething is disturbing about the rhythm. Forty years ago: an emergency in Karamoja, humanitarian mobilisation, famine narrowly averted. Today, after countless billions in aid: therapeutic feeding, donor appeals, and a new round of urgency, accompanied, of course, by dramatic photos and captions.
ReplyDeleteProgress, it seems, has stood still. One begins to wonder whether the system is designed to solve the problem or to manage its continued existence.
Of late, the enlightened in the aid community often draw a distinction: development aid may be complicated and often disappointing, but in emergencies, this is where its value is beyond question. If the same “emergency” recurs across decades, at what point does it cease to be an emergency and become something else, something structural, something political, something perhaps inconvenient to the prevailing aid model?
When the aid community steps in to prevent the worst outcomes, they save lives. But they may also relieve domestic pressure on governments. Compassion can dilute accountability.
Meanwhile, we were told by The Economist that recent reductions in aid flows to Africa may not have been the catastrophe many predicted, a view supported by several African economists. In some cases, countries appear to be adjusting, finding internal efficiencies and making harder choices.
This is not to dismiss the individual emergency aid workers on the ground who are often capable and dedicated and operate within the logic of a system they did not design and perhaps do not fully understand. But systems matter, and this one has produced situations that never quite resolve and interventions that never quite conclude.
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Delete😔 so true
DeleteI had so many typos from doing this on my phone I wanted a re-do: Thanks Thomas - those who work in emergency response or development- or like UNICEF- along the continuum- keep flogging this over and over. It could be akin to the boy who cried wolf? I was working in the Tanzania southern highlands in mid 2000s- the sacred birthplace of Urban Johnson's work on nutrition model - yet less than 30 years later hardly a trace that any of it sunk in the daily routines or choices of parents and local leaders? It is not encouraging.
DeleteLudo, thanks Detlef and friends, while I didn’t want to comment, hastily, the mentioning of dear Urban triggers a souvenir. 45 years back - with the backing of Charles Egger and Richard Reid, I decided to take-up my new assignment in Nigeria by traveling by road from Abidjan to Lagos via Ouagadougou and Niamey to say goodbye - after 5 years - to colleagues from - at that time - the UNICEF « Area Office » for six countries, with three program officers, each « covering » 2 countries, based in Abidjan, and mobile ( smile )... [ two P4s and me P3. ]. Different personalities, same purpose, same method: (indeed) with our sustained advocacy, let decentralized governance - however imperfect - assume their roles and define child-priorities themselves. Yes, UNICEF would do some fundraising for pilots where promising, but I don’t recall any « instructions « from Hqs. « Country-specificity was the goal. ok, Alma Ata was in 1978, Mini Health delegations were sent, and THEY told us how to translate into programming-by-objectives what was relevant for them. Liberia and Dahomey were slightly different,… (…) Urban’s nutrition model ( for example )was used and refined in their schools of Public Health, Watsan was internalized as a priority by them,etc…
ReplyDeleteWere we then living in a strangely for-ever gone world ? Yes. Karamoja and the Nimba Mountains had different « Situation Analyses « ,… Our grandchildren use them now for their PhDs. And are stunned by how - since - language has become « removed « from reality, on the one hand, with still some sterile repetitivity of terms on the other… At the same time, they wonder why - for the UN system as a whole - every people in the world loves inclusive development, and how suddenly all became resilient and determined to embrace the wisdom of our jargon. Social change? revolutions? Coups d’Etats? « Ruptures »? Warmongers? No, these are excluded from our reports… and not debated any more in our Executive (?) Boards… Detlef, thanks for sharing! Ludo Welffens, see you soon!
I mention Urban's name not in vein - but to demonstrate that all the good work that was done - did not ultimately sink in. I was working in the exact same districts where the nutition model was born as was human rights approach to programming - in Iringa - great stuff in the late 1980s and 90s - and with massive inputs and effort we made a difference - but then POOF - a mere 15 years later - and go to SAME districts and all forms of malnutrition are up, school enrollment is down, literacy is up, access to water is down. waterborne diseases are up. If those great things we did were so great (and they were groundbreaking) - why are so many communities not better off these days - why has development achievement plateaued or declined? We have to ask hard questions?
DeleteWithout sustained economic growth, which was absent in most countries where UNICEF worked, many of these interventions became a low priority within an environment of competition for resources once external funding ceased.
DeleteA very thought-provoking reflection. The question is no longer how many interventions have been implemented, but why communities remain trapped in recurring cycles of vulnerability after decades of aid and programming. Sustainable systems, local ownership, and long-term resilience must become the true measure of impact.
ReplyDeleteCould it be that whatever good stuff UNICEF promoted and piloted was never taken on board by our counterparts?? Or they did it just to be nice - and then after a few years we stopped noticing and moved on to other things and so did the leaders - like it never happened? It is rather sad. I heard the Karamoja most of my career in UNICEF - and anecdotal stories of the miracles performed nearby in child survival - and yet here we are?
DeleteForeign impossed ideas, without full buy-in, may be difficult to sustain in an environment with limited resources in stagnant or shrinking economies.
DeleteWe often wonder why aid programmes tied to global goals are so rarely sustainable. Perhaps the answer lies partly in our own behaviour.
DeleteWe bribed officials to move projects forward. We financed endless “study tours” that resembled shopping holidays more than serious professional exchanges. We topped up salaries, paid per diems, and created a culture in which cooperation depended on external rewards. At times, we even handed lucrative international posts to the very officials who had spent years obstructing reforms.
Then we act surprised when governments lose interest the moment donor funding ends. But why would genuine ownership emerge from a system that trained people to respond primarily to incentives, allowances, and foreign money?
So true!
DeleteAt least they no longer suffer from guinea worm.
ReplyDeleteThank you, dear Detlef, for describing – in other words – international aid as an ambulance parked at the base of a cliff picking up the endless victims falling off alps of poverty, hunger and a million natural and man-made calamities. Working as a communicator, I always thought the metaphor unfair, as we sincerely aspired to prevention and addressing root causes ... and ambulances, drivers and pilot projects were, in the end, needed and appreciated. But truth is, the post-war, post-colonial development aid system was always, and still is, a combination of noble internationalism and heroic solidarity and Oz behind the West's curtain of soft power. What worries me is that Trump uses Karamoja examples like the one you have eloquently shared to further decimate multilateral cooperation and the very notion of solidarity. Now there aren't even ambulances at the bottom of the cliffs.
ReplyDeleteRobert, why did the many billions in aid to Uganda fail to help people move away from the cliff, instead of merely waiting for them to fall? What went wrong over the past 40 years in our vision of development and aid?
DeleteThe aid industry has become too focused on its own importance and institutional interests, instead of outcomes. As a result, there has been too little honest debate about aid effectiveness. The failure to properly evaluate the impact of traditional aid, and to rethink the way aid is delivered, has also made it easier for Trump to justify cutting aid budgets, without seriously considering better forms of international and multilateral cooperation.
I worked in South Karamoja from 1982 to 1984 for an NGO as a public health doctor (during the time of Roger, as well as David Alnwick and Mark Stirling, who were in KLA with UNICEF).
ReplyDeleteI returned there in January 2025 with friends who used to work with me. In Tokora, where we work, the only difference was that there was now a Karimojong doctor. As you mentioned, little has changed 40 years later: the manyattas are now in villages with sidewalks, cell phones have replaced guns, and the Chinese have replaced the missionaries (in part)
There are far fewer herds of cows and more goats. I don’t know if this is accurate, but it seems that the Karimojong have been disarmed and that their herds have been stolen by their neighbours. It is easier to send in the army given the state of the roads. Progress (roads, access, communication) has likely contributed to the transformation of Karamoja’s pastoral society.
In Moroto and Kaboong, the UN has set up fortified camps to be "closer to the needs “ of the people; the paved road allows them to return to KLA on weekends to be with their families…
Emergencies are treated as “Groundhog Day” by staff specialised in emergencies, but also due to a lack of inside volunteers with limited experience at UNICEF. There’s no one there to step back and take a broader view, and no one to listen to him if, by chance, someone starts to question our actions…
What strikes me reading this discussion is how determined many still are to tiptoe around the obvious.
ReplyDeleteKaramoja is not merely a difficult development challenge. After forty years of recurring “emergencies,” it is evidence of a failed model. The same photographs, the same donor appeals, the same therapeutic feeding, the same solemn declarations of urgency are repeated across generations.
At some point, honesty requires us to admit that a system which permanently manages crises is not the same thing as a system that solves them.
When governments know that UNICEF, WFP, NGOs and donors will inevitably arrive with food, medicine, logistics and international appeals, the political cost of neglect collapses. Why invest seriously in preparedness or rural development when the international community reliably steps in to absorb the fallout?
That is not compassion replacing indifference. It is accountability being replaced by substitution.
Of course, aid has saved lives. Millions of them. But saving lives in the short term is not the same as building functioning societies in the long term.
If the same regions still require emergency feeding operations after billions in aid and decades of intervention, then something deeper is wrong than drought, conflict or “capacity gaps.”
The uncomfortable possibility is that the aid system has become extremely effective at sustaining itself, while being far less effective at ending dependency.
Why would a cash-strapped African government invest seriously in emergency preparedness when WFP and UNICEF are effectively permanently on standby? For many weak or unpopular governments, investing in internal security, intelligence services, and the armed forces may appear far more rational. Those institutions, after all, are what keep them in power.
DeleteThis creates a deeply uncomfortable paradox. The aid industry, however well-intentioned, can end up insulating governments from the consequences of chronic mismanagement while simultaneously freeing state resources for patronage networks, repression, and militarisation rather than development.
No humanitarian agency set out to create such incentives. Yet unintended consequences remain consequences nonetheless.
I like this discussion. After spending 40+ years doing development and humanitarian work I've become more interested in learning from successes (while not ignoring the failures). Ethiopia's Productive Safety Net Program succeeded in breaking the endless cycles of large-scale humanitarian interventions. There are a lot of lessons to be learned why such a program succeeded in Ethiopia and why many others have failed. I have learned a lot from the more critical publications of the World Bank, especially papers by Lant Pritchett and Michael Woolcock.
ReplyDeleteThis is AI's understanding of large scale emergenies in Ethiopia today: In short, PSNP has at least mitigated the old cycle of predictable, chronic rural food aid appeals for core vulnerable populations. It represents progress in moving from pure humanitarianism toward development-oriented safety nets. But Ethiopia's emergencies are now driven more by complex, compounding factors, so large-scale interventions continue. It is a partial success story rather than a breakthrough.
DeleteIn other words, GDP growth, which indeed Ethiopia had, took care of it
DeleteThe question remains: given that the PSNP has been at least a partial success story over the past 20 years, and has been extensively documented and researched, why has it not been replicated? Why have its lessons not been applied elsewhere, for example in Uganda?
DeleteIn his book Gambling on Development, Stefan Dercon devotes a chapter to Ethiopia. He argues that the country’s remarkable economic growth, projected to exceed 9% in 2024/25, was driven primarily by a shared commitment to growth and development among those in power. Progress did not stem from political openness or liberal values. Rather, the elite managed, at times with considerable ruthlessness, to govern “for the people” rather than fully “by the people,” while securing political legitimacy through development.
There are different authoritarian systems. To govern "for the people" can't be the worst. Perhaps other countries may wish to emulate Ethiopia's growth figures. That may have an impact on the recurrence of emergencies. More resources for addressing emergencies, and frankly, everything else, will always help. Sustained 9% growth will quickly make a country pretty rich. The power of compounding! Just take a look at South Korea, it was poorer than may Afican countries just a few decades ago. An appropriate question: why is this not recognised by the aid industry? Why is "beyond growth" still the mantra, driven by academics from their ivory towers?
DeleteWhat makes this discussion uncomfortable is not that the failures are difficult to understand. It is that most of them were visible to anyone who spent time inside the system.
ReplyDeleteThe revolving emergencies, the dependency, the strategic frameworks, the inflation of jargon, the obsession with visibility over outcomes, the perverse incentives, the substitution of government responsibility, the culture of allowances and per diems, the quiet tolerance of less than sterling performance as long as institutional loyalty was maintained. None of this was hidden.
Inside organisations like UNICEF, many privately acknowledged these contradictions, yet publicly, the system demanded optimism, conformity, and a narrative of “impact.”
The aid industry increasingly resembles Hans Christian Andersen’s The Emperor’s New Clothes: a large procession in which everyone is expected to admire the splendour of achievements that, on closer inspection, are often threadbare or even imaginary.
Those who questioned the model quickly discovered the limits of “open dialogue.” In many international organisations, career advancement depended less on intellectual honesty than on mastering institutional theatre: praising leadership, speaking fluent jargon and delivering polished presentations, while underlying realities remained largely unchanged.
New staff learned very quickly that criticism of aid effectiveness, dependency, corruption, incentive distortions, or bureaucratic self-preservation was not career-enhancing.
PowerPoint presentations became more sophisticated. Coordination structures multiplied. Acronyms proliferated. Executive summaries grew increasingly detached from the reality on the ground.
The uncomfortable possibility raised throughout this discussion is that perhaps the aid industry has evolved in such a manner that the institutional survival depends on the persistence of the very problems they claim to solve.
If that sounds cynical, one might ask a simpler question:
After forty years, countless missions, hundreds of consultants, billions in aid, and endless declarations of commitment, why are foreign agencies still measuring starving children in Karamoja with MUAC tapes?
At some point, seriousness requires more than compassion. It requires accountability, honesty, and the courage to admit when a model is failing.
Sometimes, one gets the impression that the aid industry may have confused “development” with “career sustainability.” One would have thought that the primary objective of aid agencies would be to work themselves out of a job as quickly as possible. The ideal success story should surely be this: a country develops, institutions function, people prosper, and expatriates leave. Instead, the aid sector resembles one of the few industries where permanent failure guarantees permanent expansion.
ReplyDeleteNaturally, this raises an awkward question: are the incentives misaligned? After all, no industry enthusiastically celebrates the disappearance of its own market. One struggles to imagine a conference titled “Towards the Successful Closure of Our Aid Operations.”
Quite the opposite. Success in the aid world appears to generate additional funding, additional programmes, additional advisers, and, naturally, additional conferences in agreeable locations.
The rhetoric never changes. Every few years comes another grand initiative, another “transformative framework,” another declaration that this time we have finally identified the root causes. One wonders whether poverty itself has become too economically important to too many people.
This is, of course, unfair to the many dedicated individuals in the system who genuinely want to improve lives and often work under extremely difficult conditions. But systems matter more than intentions. And the uncomfortable reality is that institutions, like all living organisms, tend to prioritise survival. Aid agencies are no exception.
Perhaps the most radical performance indicator for the aid industry would be a simple one: how many offices successfully shut down because they were no longer needed? That would truly be sustainable development.