During the late 2013 I spent several weeks working with two NGOs based in Zambia. Both of these honourable organizations are committed to the fight against HIV/AIDS, a disease that has caused millions of people worldwide to suffer. The nature of this suffering extends beyond its obvious adverse impact on the person’s immunity system (i.e. vulnerability to opportunistic diseases such as tuberculosis) and includes, somewhat tragically, social isolation, stigmatization, and marginalization. With the advance of modern medicine AIDS has become a treatable disease and those infected with it can, at least theoretically, lead perfectly normal lives. And yet, the disease remains a very serious medical and socio-economic problem across all of Sub-Saharan Africa.
The two organizations I have worked with, Pride Community Health Organization (or PRICHO) and Rise Community Aid Program (or RICAP) have both been for many years at the forefront of the HIV response in the Greater Kafue District, an area located 70 km south of the capital Lusaka and inhabited by more than 200,000 people. Both of these organizations have been and continue being inspired and driven by the vision to see a socio-economically empowered Kafue Community, one that is largely free from new HIV infections. As the vision of these two amazing organizations suggests, and as will be explored shortly, it is impossible to divorce the causes and consequences of HIV and AIDS from the wider socio-economic context of the local community and society in general.
Since the inception of the HIV/AIDS epidemic somewhere in the late 70ies, this terrible disease has steadily spread across the entire world. But the region by far most affected by it has been the Sub-Saharan Africa. Ironically, it is this region where the disease is believed to have originated in the late 19th century with the transfer of the very first HIV strain from chimpanzees and gorillas to humans.
Today, several factors are considered to contribute to the continued spread of the HIV and AIDS pandemic across the Kafue District, and more broadly, across all the Sub-Saharan Africa. However the underlying and principal cause for the spread of HIV and AIDS has to do with the poverty of the entire continent abandoned so abruptly, in the course of the 20th century, by the former colonial powers. This is not to suggest that the French or the British should have stayed in Africa or that they are to blame for the economic hardship experienced today by millions of Africans. It is just to point out that the economic disparity between the “West” and the “Rest” has grown in the last 60 or so years, and further, that there is a clear link between today’s poverty suffered by the millions of Africans and the prevalence of HIV/AIDS in this part of the world.
Accordingly, to the British historian, Niall Fergusson, today’s poverty and wider socio-economic problems of former colonies (not just the British ones) are caused by the lopsided nature of economic globalization and political fragmentation. Here is what Niall Fergusson writes in his widely acclaimed book “Empire”:
“The entire period from 1913 to 1973 was a time of economic disintegration, however, flanked on either side by periods of economic globalization. These delivered remarkably high rates of growth in per capita GDP – at similar levels as during the heyday of the British Empire in the nineteenth century. However, the earlier period of globalization was associated with a degree of convergence in international income levels, particularly between the economies on either side of the Atlantic Ocean, whereas the recent period has been associated with a marked global divergence, particularly as the rest of the world has pulled away from sub-Saharan Africa. There can be little doubt that this is due in part to the lopsided nature of economic globalization – the fact that the capital flows are mainly within the developed world and that trade and migration are still restricted in many ways. This was less true in the per-1914 age of globalization when, partly, under the influence of [British] imperial structures, investors were encouraged to put their money into developing economies. On the eve of the First World War, imperialism had reduced the number of independent countries in the world to fifty-nine. In 1946, there were seventy-four independent countries, in 1959, eighty-nine. By 1995 the number was 192 (driven by new states formed in Africa and the collapse of the Soviet Empire). Many of the new states are tiny. No fewer than fifty-eight of today’s states have populations less than 2.5 million. There are two disadvantages of this political fragmentation. Small countries are often formed as a result of civil war within an earlier multi-ethnic polity – the most common form of conflict since 1945 – and this in itself is economically extremely disruptive. In addition, such small states are economically inefficient even in peace-time, too small to justify all the paraphernalia of statehood they insist on decking themselves out in: border posts, bureaucracies, and the rest.”
Having been on the ground, and having seen the impact of the disease I would unequivocally say that tackling poverty would resolve many problems including of course HIV and AIDS. What’s more, getting control over the growth of the human population is equally, if not more important because you cannot fight poverty if there are ever more “mouths to feed”.
The constitution of the WHO states that:
“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”
What this suggests is that empowering people economically and socially is the key to achieving such a complete state of well-being. It isn’t enough that we fight diseases such as HIV, malaria or tuberculosis – we must also tackle the poverty.
But if we put the obvious problem of poverty aside, one that I don’t at all believe to be insurmountable, and try to nail down the direct reasons that cause the spread of the HIV and AIDS across Sub-Saharan Africa than these include the following:
The striking thing about the list above is that the items on it are all interrelated and that none of these work in isolation. In fact, there is a circular causality among these items and breaking the circle is possible if you focus on socio-economic empowerment.
In the communities impacted by HIV/AIDS, such as the one in the Greater Kafue District, the impact of the disease is felt at individual, family, and community level. Beyond the obvious physical impact of the disease, people infected with HIV suffer from psychological trauma, as well as stigma and social isolation due to the nature of the disease (or how it is transferred from person to person).
In addition, the financial impact of the diseases weighs heavily on those directly impacted by it (e.g. through the erosion of food security as well as general capability to generate income and remain productive at work). In addition, families impacted by HIV infections easily become a breeding ground for further spread of HIV infection (e.g. through sexual abuse of children by the infected members of the family or forced prostitution).
At the community level the HIV pandemic drags on the economic resources by diverting these to less productive activities such as taking care of the sick and funerals. What’s more, the local community suffers from high crime rates, increased prostitution, general food insecurity, and reduced access to most basic social facilities. Lastly, the social cohesion, or the sense of belonging among the community, is adversely affected in an environment where the sick are stigmatized and where hatred and even witchcraft are rampant.
The past 30+ years have witnessed an unprecedented commitment to- and progress towards effective HIV response. In particular, the introduction of anti-retroviral medications and increased recognition of the human rights of persons living with HIV (or shortly, PLHIVs) have contributed immeasurably towards this progress. But HIV remains a challenge. It is estimated that there are 33.4 million PLHIVs in the world today. Targets for universal access to HIV medical care and support remain largely unmet. Widespread poverty – being the principal cause of HIV across Zambia and Africa – continues being an enormous problem, one that hampers hugely the progress in fighting HIV. Lastly, the attention paid to women’s health and rights remains insufficient making women, in general, disproportionately more heavily affected by HIV than men. At the same time, funding provided to deal with HIV has generally decreased in the last years – at least relative to other donor-funded initiatives – reflecting on the shifting priorities of donor nations and organizations.
The men and women working for the countless NGOs and CBOs scattered across Sub-Saharan Africa do their best to contain the spread of HIV and AIDS, putting their hearts and hard work into this noble cause. But as with any endeavour in life, the success comes from execution and not from good ideas or good intentions. It is exactly for this reason that local NGOs, such as the ones I have worked with while in Zambia, must be relentless in:
Making these three things happen is easier said than done, especially if your access to financial and human resources on the ground is limited, a ruthless reality for the vast majority of local NGOs and CBOs across Africa. But with the help of a seasoned corporate finance professional and volunteer it is surprisingly easy to bring tangible and almost immediate improvements to how such organizations operate. Allow me to elaborate this…
Volunteering assignment lasting just a couple of weeks and at a cost of a few thousand dollars (to pay for the placement, flight, accommodation, and food) is incredibly easy to pull together, at least if you partner up with such remarkable organizations as The Accountants for International Development. It has taken me a few phone calls and a few emails and there I was, on the Emirates plane heading south. As I touched the ground of the Lusaka airport I felt anxious, and yet excited by the possibility of doing something that can make the lives of others just a bit better. Several weeks later, leaving the same airport, but heading back to Switzerland this time, I felt upbeat by the work I was able to deliver working side-by-side with the remarkable men and women of PRICHO and RICAP. To this day, I feel stunned by how much we have accomplished and with how little.
Take the strategic review of PRICHO’s imperatives for the years 2013 through 2017, for example. A well-articulated and complete Strategy Plan, built bottom-up with the involvement of all local stakeholders and in alignment with the donor’s imperatives, is a prerequisite for moving PRICHO’s activities in the right direction. The overall quality of its Strategic Plan is also important because it serves to promote it to potential donors, in an environment where competing for funds is a daily necessity for all but a handful of larger and more established organizations. This is where I was able to offer some help, reviewing and assessing the quality of the Strategy Plan, identifying gaps to be filled, re-writing parts of it to make it sound coherent and, lastly, bringing an unbiased outside perspective. And by no means do I consider myself to be an expert in the field, but I do admit that my business experience along with my broader interests and skills have made me ask the right questions and steer the boat down the river. The end result was a very solid and attractive document, that would serve as a foundation of PRICHO’s direction for the years to come.
Another area where many of the smaller NGOs struggle with, and where a finance professional can certainly help with, is putting in place a reserve policy to build an endowment fund. Such a fund, or simple a pot of money, serves as an insurance policy against a sudden drop in funding income – a real possibility in the world where one corruption scandal in the ranks of the local government can cut out funding from top donors such as the Global Fund. This is not a hypothetical scenario, it has actually recently happened and the corrupt officials were those in the Zambian Ministry of Health. But, regardless of why funding may dry out, it is a fact of life and one that must be anticipated. Put differently, the financial sustainability in the NGO context is about generating streams of income to finance ongoing activities but also to have “money for the rainy day”. And so, I have engaged with the local Executive Director of PRICHO and his team in discussing real and practical means of generating income, so there is money available in the future to pay salaries and office costs. What’s more, we have jointly developed a simple but powerful cash forecasting tool by donor program and consolidated it to show the overall current and future cash position of the organization – an eye-opening exercise I was told.
Lastly, many of the smaller NGOs struggle to create and operate within an internally transparent financial framework. The single and most important element that underpins transparency is having a set of reliable financial and accounting processes whereby all the financial transactions are captured easily, accurately and timely, and where there are solid internal controls to prevent fraud or misappropriation of NGO’s assets. Admittedly, this isn’t always easy, especially if there isn’t enough money around for hiring a strong accountant or for putting a simple ERP system in place. Another challenge is to balance the needs for transparency and accountability with the ease of administering such a framework – remember, NGOs have very limited resources and these must be expedited efficiently. As my experience has shown, it is possible to design in a week a cash-based (as opposed to accrual-based) accounting system in Excel, with controlled input, and inbuilt checks and validations and further to map out the right process of accounting for how money comes in and goes out. I would like to think that the work I did made quite a difference to the quality of data captured and information generated to report internally and to donors.
In assisting both RICAP and PRICHO, I have found it of utmost importance to first and foremost understand the needs of the organizations I was working for. Scoping out my assignment was infinitely more important than performing the actual work, it aligned me with the most pertinent needs of my hosts and motivated me to work relentlessly to meet these needs. I must give credit to a remarkable website I have found, one which has become an instant and bottomless resource of information, tools, and everything else you would want as a volunteer. This website is to be found at www.mango.org.uk, and I cannot praise it enough to any finance professional working with an NGO. Equally, I must thank wholeheartedly my program coordinator from AFID…what a difference she has made in supporting me all along.
Volunteering isn’t a one way-street where the benefits of it accrue only to one party, i.e. the NGOs you work with. In actuality, there is probably more in it for you. Besides an unforgettable experience of viewing white rhinos or staring in awe at the Victoria Falls, one of the biggest benefits I have found is that volunteering in Africa allows you to enlarge yourself as a person, and considerably so.
In our daily lives, especially if you live in the “Western World”, we are comforted by the daily conveniences such as access to supermarkets or broad-band internet, by the affinity and love of- and for our family and friends, by the financial security brought by our highly paying jobs, and zillions of other things that make our lives so easy. And yet, nearly all of these things evaporate the moment you go out there to a remote and secluded destination – at least by the standards we are accustomed to. I recall the first hot shower I took after my return home, it was indeed a treat, and I indulged myself in it for a full hour.
Besides, going on a volunteering assignment will help you rid yourself of whatever negative stereotypes you might hold about less developed parts of the world. You will learn that, below the surface of a different skin colour and cultural background, people out there have dreams and passions, that they care for their loved ones, they enjoy being with friends, fancy music and football, and that they pursue happiness – just like you and me.
If anything, this experience has made it possible for me to transcend race and nationility and to transform my self-awareness into that of the global citizenship. We are all in the same boat, linked beyond physical, cultural and economic frontiers that artificially divide us. For this reason and for this reason alone, we should never close our eyes to the needs of others. As Martin Luther said:
“Man’s inhumanity is not only perpetrated by the vitriolic actions of those who are bad, they are also perpetrated by the inaction of good.”
If getting involved with an NGO is something you would like to do, if this article has inspired you just a notch, then I encourage you to make it happen now. Remember, inspiration is perishable and it carries an expiry date. If you don’t plan for it now, you are unlikely to plan for it in the future.
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