Bloomberg Businessweek reported today that a recent World Bank study in Malawi shows that providing girls with school fees and a small cash incentive helps deter them from engaging in inter-generational relationships. However, can these cash trades actually put an end to the Sugar Daddy phenomenon in sub-Saharan Africa? According to Bloomberg, the bottom line is: “Cash payouts may be the first successful non-biomedical approach to reducing HIV prevalence in sub-Saharan Africa.”
Public health workers and policy analysts often argue about the difference between efficiency and efficacy in HIV/AIDS interventions in Africa. Many interventions that are efficient at preventing the spread of HIV/AIDS are not effective in certain communities. No where on earth does a long-term couple prefer to use condoms, even though condoms are 95-99% effective in preventing HIV transmission. In addition, while male circumcision has proven to be efficient in preventing HIV infection and helps prevent a host of other infections for both males and females, in certain places, circumcision goes against religious and cultural beliefs.
At the same time, we have to discuss the efficiency of certain interventions and the possible negative externalities that they can have on the target population. Just because a particular intervention is effective within a community, does not mean that it is either efficient or in the long-term best interests of the community. The World Bank’s findings are a bit useless in the context of sub-Saharan Africa and if implemented by NGOs could have hugely negative repercussions in the future. First, sub-Saharan governments are already struggling to achieve universal primary education, let alone having the cash on hand to subsidize education for secondary and tertiary age girls and provide them with stipends large enough to overcome the incentives of intergenerational relationships.
Second, handing out cash to communities is typically a bad idea. Providing compensation for time during a focus group discussion or training session is one thing. Handing out cash, contingent on changes in behavior is another. This looks a lot like conditional aid to countries, only at the individual level. This sets a bad precedent for governments. What happens when the government runs out of money? The problem will revert back to what it was before, but could be exacerbated by rising frustrations and even protest from those who once received the funds.
What if NGOs implemented the cash incentive programs instead? This could potentially set an even worse precedent. Expat creed #1 is to never hand out cash, unless it is for compensation for something that has already transpired. The worst thing that development organizations can do is simply hand out wads of cash to individuals. This presents an image of the West as bearers of free money and builds up a dependency complex in which donors are seen as saviors rather than partners.
The World Bank was on the right track in recognizing that poverty and lack of opportunity are major causes of intergenerational relationships. However, their band-aid solution will end up causing more harm than good. Instead, we should be talking to women involved in intergenerational relationships to find out what the opportunity costs are for them in limiting their relationships to their age group. Then we need to try to find solutions to these costs that are attainable, sustainable, effective, and efficient.