For many feminists, sex work - or prostitution as they would prefer to call it - symbolises oppression, victimisation and the exploitation of womanhood. These feminists look at the provision of sexual services through the framework of a rigid understanding of patriarchy, viewing it as objectifying women’s bodies, and as the commercialisation of sex. Hence, for feminists, prostitutes are victims of unequal power relations between the sexes. No ‘real’ woman would agree to do sex work, because if she does she is living under the illusion of ‘false consciousness’. We hear radical feminist activists talk of prostitution as ‘female sexual slavery’ and ‘sexual victimhood’. Exchanging sexual services for money [sex work] comes to be conflated with selling of a body to another [trafficking], and the figure of the ‘prostituted woman’ comes to represent the ultimate victim of male power. By describing prostitution as violence, they foreclose any discussion over whether women can actively choose sex work as a livelihood option.

These perceptions echo the early reformist discourse, which view women as needing to be protected, preferably by laws, from lustful men. But what becomes difficult for these kinds of feminists to countenance is that for some women, in some contexts, sex work is a livelihood, a business, a form of employment that they have little desire to be ‘rescued’ or ‘rehabilitated’ from pursuing. And what is even more troubling for them is that the image of the innocent victim lured into a life of hopeless moral turpitude comes to be shattered when real sex workers come into view.

A particular strand of feminism joins hands with the extreme right wing that informs the anti-trafficking discourse, in which prostitution is viewed as a form of violence against women. Such discourses are often from privileged positions of class, race or caste, and they analyse the trading of sex through a narrow framework. This in effect limits an understanding of sex work, epitomising sex work as oppression, victimisation and exploitation of women and constructing the women only as victims of unequal gender relations.

Violence against women (VAW) has focused on domestic violence, rape, sexual harassment, acid throwing etc. When VAW is conflated with sex work, it becomes difficult to see the wood for the trees. For example, most sex workers report that they experience violence and exploitation by and large at the hands of police and petty local thugs, rather than in sexual relations with clients. It is conveniently forgotten that a greater incidence of VAW occurs in marriages than between sex workers and their clients. It is especially ironic that much of the violence that does occur within the field of sex work is perpetrated or sanctioned by the state, such as the violence used to justify severe action against the sex work industry such as closure of brothels and ‘clean ups’, and the ‘raid and rescue’ operations instigated by dubious foreign organisations with moral agendas of their own.

The conflation of sex work with trafficking and violence against women has presented major obstacles to initiatives working for the rights of sex workers. For example, in 2005, an American evangelist working for the anti-trafficking NGO Restore International arrived in Sangli - where the sex worker collective VAMP (Veshya Anyay Mukti Parishad) is based - and, with assistance from local police, conducted several brothel raids. An assumption had been made that all the young women living in the area were doing sex work, had been trafficked, and needed ‘rescuing’. Thirty-five women were picked up and sent for medical examinations to determine their age. They were detained for several days at the behest of Restore International. It was found that only four women detained were underage, out of which two were not doing sex work but living with relatives in the area. The women received no apology or compensation for loss of income, and the organisation has continued to conduct raids periodically. Sex workers’ organisations such as VAMP face an ongoing struggle with a powerful set of players who misconstrue their work, interpret the business and empowerment successes of the women as necessarily involving illegal practices, and take on an aggressive policing role under the mantle of moral authority.

The casting of the prostitute as the victim has engendered several positions on prostitution. Because women are conceptualised as ‘slaves’, one approach is to put a stop to prostitution in the literal sense - by demolishing it. The state and other establishments, such as NGOs, often use this abolitionist approach. Another feminist position posits that women in prostitution need reforming because, as women who do sex work, they have no ‘character’. Rescue and rehabilitation strategies are used here. The assumption is that women need saving from sex work and then rehabilitation by giving them alternate jobs. A third strategy, the regulatory approach, relies on laws. This does not take the stand of banning prostitution but rather accepts that prostitution is here to stay and needs regulation. Laws like the 1956 Immoral Traffic Prevention Act (ITPA) in India, is a reflection of this approach. Yet another approach is the rights-based approach - which is silent on the merits or morality of sex work, per se, and contends that women in sex work should have the same rights and entitlements as any other citizen, and the state must act as the duty bearer of these rights.

It is the last of these approaches that sex workers themselves are mobilising around. Collective action and the growing visibility of their movement for rights and recognition is enabling sex workers to dare to break out of the victim mode and demand that they be seen as real human beings with rights, needs, fears, hopes and aspirations, just like anyone else. After decades of struggle, they are now slowly beginning to be recognised as persons and citizens. What we learn if we listen to them is that one of the biggest challenges they face is that of stigma. Stigma is a double-edged sword. It produces exclusion - sex workers frequently experience societal discrimination, barriers to access to services and, sometimes, violent means of enforcing social divisions that keep them out of public spaces and institutions. And this stigma also manifests in the undue amount of unwanted attention that sex workers are faced with from the state, NGOs and religious organisations who often have little interest in their rights and empowerment as workers and see them merely as instruments and objects.

In order for the stigma of discrimination to end, and fundamental rights extended for sex workers to carry out their livelihood, societal perception must be transformed. To make the big change happen, small steps must be taken. To speak, to stand up and be counted is a step forward in the campaign for rights - the right to dignity, to work, to earn a livelihood, to education, to health and leisure - rights that are available to all citizens. Rather than leaving sex workers out of the conversation, it’s time that feminists started listening to what they have to say - they may learn a trick or two about bargaining with patriarchy, as well as come to a more humbling understanding of the role that feminists might play in the bigger struggle for rights, dignity and freedom in which sex workers are leading the way.

So I would disagree with Meena and say that the conversation has been there, filled with eye-opening moments, wondrous discovery, beautiful friendships, leading to a growing breed of feminists of another kind: those who collaborate with sex worker collectives to mainstream their voices as much as possible; those who do take up cases and run with them; those who do all sorts of other work supporting them; those who write year after year from their point of view – even if no one is reading or wants to hear what they have to say.

But still. Things. Aren’t. Changing. Why is this? Because it is not about just having  a conversation but deeper moralities within people, as well as an absolute lack of clarity on how to change moral ideas or dislodge cultural understandings of what it means to be a ‘good’ and a ‘bad’ woman, how to actively dismantle that ticking bomb called stigma. It isn’t just sex work - look at continued controversies globally on abortion laws – but a larger basket of issues that seem to be governed by an invisible, irrational, seemingly more sacred ‘moral law’. The ‘silence of the rights based approach on the moralities of sex work’, as Meena mentions, is partially to blame – perhaps this is because people who are human rights defenders themselves have conflicting views on sex work.

It’s also because many of us struggle with the everyday, and succumb to let’s say, ‘trafficking fatigue’. What is it that sustains the zeal of the trafficking missionaries – the passion with which they continue rescuing and reforming women in prostitution? Is it the media attention, the many awards that they get, the continued funding, the self-righteous satisfaction? Why have the counter-initiatives lagged behind? Some are overwhelmed with other issues – the broader VAW issues Meena speaks of; struggling with rising pay scales that means they can afford fewer of the brightest activists and academics who move to donors or larger INGOs; new reporting formats that rapidly consume time; all those pragmatic thorns in the non-profit bush.

I feel though that Meena’s piece hinges too much on a dichotomy that is fast fading. We are today looking at a landscape where sex and labour are overlapping in many more ways than just straight up prostitution/sex work. The question to me has moved beyond the dichotomies of prostitution as violence or work. But where is the space for multiple positions on an issue? Where is the space for a case by case assessment of a situation? How can we deal with the contradictions? Let me give you some examples: is it ok to be vocal on sex workers’ rights but to maintain that cheerleaders at the IPL (Indian Premier League - a globally-hyped, franchise-based, cricketing tournament) are a form of entertainment that is problematic? Is it ok to say that adult women should be able to choose to do sex work, but that we must find ways to enable those who want to, to move to other livelihoods without the fear of being called a reformist zealot? Is it ok to accept that some women transact sexual services and wish to continue doing so, but be troubled that sexual slavery also does exist? We need a stronger middle ground that doesn’t crack beneath these contradictions and float us to one or either side of the extremes.

We have to also start talking about new things – not just choice, consent or labour any more, but unequal gender relations, relationships, power, money, the state, corruption, poverty, violence. Perhaps even, once again, trafficking. We are on the same side. Sex workers being raided and reformed, feminists having to constantly prove (still, even after all these years) that when sexually assaulted women don’t ‘ask for it’, we are dragged through fire by a reformist discourse that is deeply institutionalised and sanctioned by the state and its mechanisms,  people who (wo)man these institutions, and sometimes even our bedfellows: the larger development/HIV/nonprofit sector. This is a challenge as much for feminists as for sex workers. I think it is time sex workers stopped seeing feminists as their opposition – the enemy lies elsewhere.

In Brazil, for instance, while debates regarding the “sex wars” raged on in the English-speaking world, the feminist movement here was engaged with other topics. During the 1970s and the first half of the 1980s Brazilian feminism concentrated on the struggle against the country’s dictatorship, on combating domestic violence and, later, on reproductive rights. Prostitution was not a central issue, but it received some attention, generating ambivalence regarding the commercialization of sex, but also arising in new perceptions about sexuality.

In the Brazilian context, the idea of sex work as the extreme exploitation of womanhood gained strength later, and by the end of the 1990s it was associated with the expansion of the anti-trafficking debate which by and large ignored Brazilian sex workers’ organizations. In the feminist universe, this expansion was intimately connected to the enlargement of transnational feminist networks. Yet, these feminist ideas are not “responsible” for the paths followed in anti-trafficking policies in Brazil. In this country, an array of different interests has capitalized on feminist discourses in order to develop anti-trafficking agendas that do not consider sex workers’ interests at all.

However, convincing feminists to pay attention to sex workers’ voices regarding what they, in fact, perceive as violence, would be a relevant step in avoiding the conflation between sex work and trafficking in policies that, using a feminist approach, restrict female migrants’, including sex workers’, rights.

Jin also said she supports her kids and her parents with her own income, she is a mother and a daughter. I would say Jin is a feminist, however she may not want that identity herself, since there are other feminists there framing her and her co-workers as victims.

It is a real pity that some people call themselves feminists viewing sex work as objectifying women’s bodies, and as the commercialisation of sex. They fail to see sex work leads women to freedom from unpaid house work and liberates women from patriarchy kinship and households that are often ruled by men. These people also fail to see women’s bodies are not there to be exploited by men, but to be made use of by the women themselves for their own purposes.

For these feminists, they see themselves as savers and saving victims who are falling into the sex industry and being exploited. They would feel lost if the sex workers themselves are willing to take sex work as work, as liberation, as freedom; and they would then have no-one to save but themselves.

If these feminists haven’t learnt a lesson from real life, then the sex worker can teach one: emotional and intimate relationships cause  more violence than sex worker and client relations. Studies show that one-third of domestic violence happens within families and intimate relations. Feminists should really challenge the marriage institution, save women from entering violent relationships and becoming house wives, rather than saving sex workers.

Indian Sex Workers are a shining example of women’s empowerment

See The Guardian Poverty Matters Blog by Andrea Cornwall ]]> http://www.contestations.net/issues/issue-5/indian-sex-workers-are-a-shining-example-of-womens-empowerment/feed/ http://www.contestations.net/issues/issue-5/recent-publications-3/ http://www.contestations.net/issues/issue-5/recent-publications-3/#comments Tue, 26 Feb 2013 14:50:54 +0000 jenny http://www.contestations.net/?p=1038 Sexuality and Empowerment:  An Intimate Connection

Sex Work and its Linkages with Informal Labour Markets in India
Rohini Sahni and V. K. Shankar

Image used with kind permission from the ‘Most Significant Change’ Technique: A Guide to its Use’, by Rick Davies and Jess Dart

Human rights, including women’s rights are dropping off the donor agenda. ‘Give it another two years’, said a United Nations official off the record recently, ‘and they will have completely disappeared’. 

Recent years have seen a marked shift in official development discourse, with less emphasis on a rights-based approach and more on an efficiency approach to gender equality, a tone set by the World Bank’s 2006 action plan – ‘Gender equality is smart economics’ which a number of official development agencies committed funds to resourcing.  Other equally disturbing trends are emerging, such as DFID’s adoption of the Nike Foundation’s ‘Girl Effect’ theme of ‘stopping poverty before it starts’ by ‘investing in girls’ – an approach that entirely ignores the historically derived structural inequities that are keeping many millions of girls [and boys!] in conditions of poverty.

Nike’s message is a simple one. It is communicated in a slick two-minute animation, on YouTube and at www.girleffect.org. Take a look.  It paints a picture of ‘the other’, living in a situation of dirt, disease and despair. A girl surrounded by flies,  taken out of the context of her family, community and country, objectified as the solution to the world being ‘in a mess’.  It paints a totally unreal picture of linear cause-effect change. Based on the mantra ‘invest in a girl’ it tells us there is a single, simple solution and we can stop worrying about the historically derived patterns of injustice and inequity in the world. Nor do ‘we’ have to either bother with finding out more about what is happening in the lives of people in poorer parts of the world nor how they perceive their own lives and how they want to make their own futures.

It is a message that is profoundly anti-rights. And it is one that says nothing about where boys - and men - might come into the picture.  It ignores notions of justice and equity in relations between people and countries that underpin a rights based approach.  The seeming triumph of the 1990s had been that social justice was seen as a sufficient reason for efforts to be made to secure gender equality. Women’s and girls’ well-being was an end in itself. Today, it is all about calculating the rates of return from investing in a person as if she were a piece of machinery.

Removing the realisation of rights, including women’s rights, from the donor agenda is part of a wider tendency to define development in terms of instruments – immunisations, bednets, numbers of children going to school, quotas for women in parliament – rather than xxx [you choose a good word, I was going to put “the social changes needed to make a fairer world”]. So we see investment in immunisations and bed nets rather than in x and y. This reflects the growing influence of large corporate sector philanthropic organisations and of the big accountancy companies. Technical solutions are sought for what are perceived to be technical problems.  ‘Value for money’ becomes equated with aggregated numbers rather than with value in supporting social transformation.  A very senior high level official from an OECD government was recently heard to remark to a group of international NGO representatives that he wanted maternal mortality to be approached as ‘a simple problem with a simple solution’.

Gender specialists in donor agencies are well aware of these challenges. One spoke of holding back on proposing to Ministers any revision of the agency’s ten year old gender equality strategy because of the fear that any revisions would be retrograde.  Another noticed the shift that had occurred with a change of Ministers. It was alright to fund women’s organisations for ‘budget monitoring or training birth attendants’ but there was  an aversion to the language of ‘rights’ because it sounded too ‘political’ and risked ‘rocking the boat with the partner government’.   This does not mean, she continued, that colleagues in country offices have abandoned a women’s rights and social transformation agenda. They use their knowledge of bureaucratic processes and discourse to fund projects under the radar.

Many donor governments are imposing extraordinary demands for reporting against quantifiable achievements as a measure of impact.  But in order to be able to count exactly how each penny or Euro of aid money gets spent, donor governments are risking not making any difference at all.  They can show how many kilometres of roads they have built or numbers of girls staying on at secondary school, as compared with before they started the projects. But development practitioners learnt many years ago that without local people empowering themselves to change the less tangible factors that cannot be counted but that have been keeping them in poverty, then when donor money stops the roads will crumble away and the next age cohort of girls won’t get to school. If this lesson is forgotten, instead of securing ‘value for money’, donor governments risk wasting money.

Donor demands are having an effect on all those organisations that are funded by donor governments, such as United Nations agencies, development research institutes like my own  and on non-governmental organisations (NGOs) like Oxfam International, all of whom pass donor government demands down to the organisations they are partnering in developing countries. The director of a women’s rights international NGO said ‘Anything that can be counted more easily is becoming more popular’.  Power, relations, the partiality of knowledge and complexity are ignored, as are surprises and positive and negative unplanned consequences. Staff of a European NGO that receives government aid money have been literally tearing out their hair as they are asked to produce standard across-the-board indicators that will distort and constrain the work of the great variety of networks they are partnering. I was recently copied into this email:

“Try to imagine: generic indicators for 23 alliances that represent an enormous diversity in all dimensions you can think of, except that they get their funds from the same source. And that after everybody worked for a year on their own objectives, intended results and indicators. It is impossible in itself and it discards all the work done over the past year. They simply changed the rules of the game just metres before the finish. And of course it boils down to even more reporting requirements.”

Some learn to play the game, going through the design and reporting hoops to get the money. Some struggle to continue to facilitate real change while pretending that they are doing what the donor expects. Other less adept at these games, get pushed aside and close down. Yet others are trying to be more selective about their partnerships, looking for those donors who have a more holistic understanding of how development happens.  However, the number of such donors appears to be rapidly declining.

The shift to the political right in many OECD countries has made governments reluctant to use aid money for advocacy and opt rather for the more technical and tangible quick wins, something also seen as vital to demonstrate at a time when public expenditure cuts puts aid flows at risk.  Even in those government agencies such as Sida that have not abandoned a women’s rights agenda, the domestic political environment’s demands for counting only what can be measured is having a serious distortive effect on the quality and sustainability of their rights-based programming.

Sustainable progress towards a fairer world requires people working together to change what is wrong with their society. International aid can help when donor organisations are prepared to support locally generated, sometimes messy and frequently unpredictable processes of positive change.

But today, many donors only want to fund projects for which the exact outcome of their support can be attributed to the donor and determined in advance. This ties the hands of aid recipient organisations. It takes away their ability to consult with their members in response to a local context always in flux.   It stops that process of empowerment that happens when individuals and organised groups are able to imagine their world differently and to realise that vision by tackling the injustices in their society.

Some very senior officials are now waking up to the hazards of the runaway ‘audit culture’ that is transforming development. The former head of the US Government’s aid agency recently wrote that those development projects that are most precisely and easily measured are the least transformational, and those projects that are most transformational are the least measurable.

At the moment Michelle Bachelet is trying to raise money from donor governments to make the new UN agency for women actually do real work to support the realisation of women’s rights. There is a very real and current danger that the donors will be placing such extraordinary demands on the agency that it will find it almost impossible to fulfil its mandate.

This is a call to action. Don’t just leave this to monitoring and evaluation experts to worry about. It requires a massive push back from women’s rights activists to make the space for social transformation that donor action risks shrinking.

Rosalind Eyben
Institute of Development Studies

We all know this is too simplistic. Improving women’s control of their reproductive lives requires challenging the barriers that prevent them from making choices about their bodies and sexuality, and the most entrenched of these barriers are structural – systemic violence against women and girls, gender discrimination in accessing services, inequalities in sexual relationships as well as in public life, the low status of women in society. Safeguarding women’s bodily integrity and autonomy is thus a profoundly political endeavour to do with changing unequal power relations and structures. It is also fundamentally about human rights - the right to be able to control what happens to your own body. 

As women’s rights advocates, we are thus faced with a complex terrain to navigate. Our cause is being championed but not in the way we intended; it has been sapped of political intent and reduced to a technocratic problem. DFID’s ‘unrelenting focus on results’ – as proudly proclaimed by the UK International Development Secretary, Andrew Mitchell – incentivises and intensifies this technocratic, de-political approach to women’s empowerment, and to development more broadly. As scrutiny of DFID’s spending intensifies in light of public disquiet about the safeguarding of the aid budget at a time of deep cuts elsewhere, ‘results-based aid’ and ‘value for money’ have ascended to ‘the very top of the UK’s development agenda’. Of course, we all want UK aid to have the greatest possible impact on the lives of the poorest women and men. But there is a real risk that resources channelled towards catalysing less tangible, more qualitative, and longer-term changes in people’s lives will evaporate under this pressure – for example, those relating to shifts in women’s control over their bodies, their sense of agency and self-worth, perceptions of personal security, or shifting attitudes about women’s roles in society.

Mitchell declares this not to be the case.  But why are the indicators in DFID’s new Business Plan so concerned with counting - ‘numbers of bed nets distributed’, ‘numbers of toilets built’, ‘length of roads built’ – rather than also seeking to capture the social and structural changes needed to end poverty and make the world a fairer place? Despite the rhetoric, there is only one indicator on women: ‘number of births delivered with the help of nurses, midwives or doctors’. This doesn’t seem a very ambitious reflection of the promise to put women at the heart of development.

The ‘unrelenting focus on results’ is likely to close off vital spaces for honest reflection on what hasn’t worked, as CSOs anxious about securing resources in a fragile funding environment will have too much to lose from highlighting failures. Particularly for women’s rights work, where changes to the status quo often lead to backlash, results-based aid is especially problematic, because reversals can be indicative of an approach that is working.

I hope DFID and other donors will seriously engage in the difficult process of developing indicators capable of meaningfully capturing shifts in the power relations that mediate women’s access to resources and rights, security and autonomy. I hope this will be done in consultation with the people who are best placed to articulate what ’success’ would look like – and that is not middle-aged white men in London. And I hope UK civil society will become more ambitious in the changes we advocate for - not merely asking repeatedly that women be ‘added’ but demanding fundamental changes in the discourse so that development becomes about seeking the transformational changes needed to create a fairer world.

Emily Esplen
(written in an independent capacity)

Here I want to meet the technocrats on their own ground by sticking to the narrow concepts and methodology of economics. I will argue the technocratic approach to be logically incoherent - and a confrontation with “rights” to be logically unavoidable.

Let me begin with a seemingly innocuous example: women’s labour force participation. One does not need a randomised controlled trial to establish “the strength and extent of the underlying evidence” that more work leads to more income,  i.e. increased female labour force participation furthers “development,” as measured by income per person.

Indeed, it is obvious to each of us that we could increase our own “development” (income) by working longer hours. We choose not to do this, however, since none (or at least few) of us are working the biological maximum of say, 16 hours a day, 7 days a week. If someone forced us to work longer hours, we must inevitably feel worse off, because we had already rejected that option when we had the right to choose. The technical economics point here is that income is no longer a reliable indicator of well-being once the right to choose is violated. Hence, “development” recommendations cannot make sense in a rights-free vacuum – respecting individual rights is a pre-requisite to any intelligible discussion of development policies as a way to increase human well-being.

I doubt the adherents to the technocratic view would disagree with anything in the preceding paragraph. Yet in practice, the technocratic discussions have a blind spot. I can’t remember the last time I saw a discussion of female labour force participation ask whether increased work is something that women themselves had the right to choose or decline. It is not exactly a secret that women around the globe often do NOT have this or other basic rights, and that there ARE a lot of men (or even other women) coercing women. Yet the technocratic approach heedlessly blends together in its “strength and extent of underlying evidence” cases of coercion, freedom of choice, and everything in between. And this blindness to individual rights occurs not just in female labour force participation, but in virtually every issue (including those affecting low-income men).

Why does this blind spot persist? I hypothesise that the technocratic vision is imbued with the unconscious paternalistic strain in development, in which “we” choose what is best for “them.” Although it is usually taboo to say “them,” development discussions frequently use the “we”. To be fair, I am guilty myself: despite criticising the “we” usage for a while now, I still slip into it.  It follows from the founding principle of development: that “we,” the “more developed” peoples, have some useful ideas, skills, technologies, etc. to convey to the “less developed.” Indeed, it would be foolish to deny the existence of any such potentially useful transfers. The difficult balancing act is to exploit such transfers while at the same time recognising the inequality in power between rich and poor, which raises big risks that “we” the rich will ignore or violate the rights of “them,” the poor. The technocratic experts, in contrast, are impatient to just get on with it, not to bother with some fuzzy and incomprehensible rights approach.

Not to make too much of one video, but the “Girl Effect” is unintentionally and usefully illustrative. The paternalism is already on display from the moment that it is about a “Girl,” and not about a “Woman.” Next follows the stereotype of the flies buzzing around the girl. As Alex de Waal and many other writers have pointed out, the aid business has long been saturated both with images of children and with degrading images of the poor, now often labelled “poverty porn.” The “we” appears in the first step in the technocratic transformation of the girl: “let’s put her in a school uniform.”

After further transformation, the “girl” convinces “the men” that “all girls are valuable.” The technocratic approach thus agrees about the desired endpoint of equal rights for women (and nobody should imply otherwise).

Yet the technocratic approach never really tests the proposition (which many would consider naïve) that technocracy will eventually yield equal rights, despite the technocratic veneration for “evidence.” Nor does the technocratic vision consider how much “we” may violate such rights (or unintentionally support such violations by others) of “them” along the way. Even if there were such evidence, it would not address whether the final state of equal rights made it “worth it” to violate rights along the way, and above all - who gets to decide?

Putting rights at the end inevitably enmeshes “us” in a tangle of paradoxes in which it will always be unclear who is benefiting from whom, or who is harming whom. Rights must come first, not last.

William Easterly
NYU Economics Department

Notes

¹ Glassman and Temin were responding to a critique of the “The Girl Effect” by Anna Carella.

Where does the problem lie? Rosalind identifies a tendency amongst some donors that certainly needs challenging. But not all donors, nor all of the corporate sector derived philanthropy initiatives, fail to promote a social change agenda. Indeed I have been struck by the great interest of US-based donors in supporting human rights, in their broadest terms − challenging inequities in distribution of resources, recognition of people as equals and the right to participation in social and policy decision-making. Given this, it seems paradoxical that the instruments that are used to measure change are unsuited to the task.

If just a tiny proportion of the money donors are willing to invest in finding quick fixes for HIV/AIDS, for example, were invested in testing interventions to shift the sexual cultures that are responsible for fuelling the AIDS epidemic in many countries, there would be more evidence available of what works well and what does not work well in diverse contexts. The desire for a quick fix is so dominant that even where there is evidence of the effectiveness of social interventions from evaluations using clinical models such as case controlled trials, few institutions or donors are keen to scale them up because this requires acknowledging complexity and that change takes time − interventions such as Stepping Stones, Inner Spaces Outer Faces, and Health Workers for Change come to mind. Institutions are more comfortable counting the number of people who have taken up anti-retroviral treatment, than counting and addressing those who subsequently drop out, let alone addressing causes of transmission including sexual violence, lack of sexual autonomy among women in particular and people’s use of sex in navigating poverty. 

Another factor that limits the possibilities of a transformative agenda among many donors is the use of their resources to support people and buy goods from their own countries – whether out of comfort or obligation. This creates a situation where expats fill Departments of Health, coming and going over a few months or years, with de-contextualised solutions marketed by US and European Schools of Public Health. A transformative agenda would see donors endowing local Schools of Public Health in southern countries, with strong governance, and funding to build PhD programs and training for health managers so as to consolidate national capacity over the long run. We are starting to see some moves in this direction, for example with the Africa-initiated CARTA programme, where nine universities in seven countries are building their own PhD programme, initially for their own staff. The solidarity provided by some European and US donors and universities, willing to support this locally shaped initiative, offers an alternative option others would do well to explore.

We know enough about what makes for policy change and for changing social norms and values. Donors  need the courage to acknowledge that it is only by supporting long-term capacity development and social interventions by and with those most affected, that ongoing dependence on donor funding can be ended.

Barbara Klugman