Perverse Payment by Results: frogs in a pot and straitjackets for obstacle courses


Robert ChambersRobert_Chambers200

Perverse  adj. deliberately deviating from what is regarded as normal, good, or proper (Collins English Dictionary)

The Department for International Development (DFID) claims to be a world leader in developing results-based aid, and now Payment by Results (PbR).  PbR means that recipients will have to show results before they are paid. It will help to share risk, we are told, and radically re-balance accountability.  It makes sense for DFID ‘to take a tougher, more business-like approach by requiring results up front before payment is made.  Better sharing of risk in this way will drive value for money as partners become more incentivised to deliver’.

The drift of the past two decades away from participation and towards top-down controls and upwards accountability has been continuous and gradual, a heating of the water in the pot. The logframe, results-based management, upwards accountability, delivering value for money, business cases… these are motherhood and apple pie words with their mantras and procedures.  They have to be good.  More of them has to be better.  But what has been happening to the frogs in the pot as these procedures intensify and heat it up?

Inside the DFID pot, am I right? More managers have been recruited who have no experience of development. Total staff numbers have been reduced while budgets have increased! (Before he became Secretary of State Andrew Mitchell said in public on two separate occasions at the University of Sussex that to do this would be ‘ridiculous’). But it is worse than this.  The staff to funds ratio has declined while in the name of accountability and value for money internal procedures have become more and more laborious and staff intensive.  Not least of these is making the business case for a project, which is much the same time-consuming effort for £500,000 as for £50 million, 100 times as much.  So staff are more tied than ever to their headquarters and offices, have less and less time for ‘the field’ and actually grounding and learning the truth for themselves of what is going on, at a time when aid is going out in bigger dollops.  Value for money? The DFID frogs in the heating pot have forgotten (or the recent tadpoles never knew) what it used to be like. The frogs already there socialise them into acceptance. And how can they jump out?  They need the water – work, careers, and (unspoken) the power that comes with increasingly stringent upwards accountability.

Realities beyond the pot

And outside the DFID pot, the recipients or would-be recipients are facing obstacle courses of complexity, emergence and unpredictability.  This applies markedly with NGOs and with research – NGOs work in highly risk-prone environments, research would not be needed if the results were known – but  DFID funding has increasingly become a dysfunctional demoralising nightmare with escalating risks and transaction costs. Goals and targets have become more rigid, measurement has taken over from judgement, linear Newtonian thinking and action denies and obliterates non-linear realities, motivation has to be ‘incentivised’ by carrots and now with PbR the sticks have no carrots at all, relationships have become distant, trust, discretion and flexibility have gone out of the window and reporting becomes more of a misleading nightmare.  And as aid monies go in larger lumps to consortia so transaction costs are transferred from inside to outside DFID, and unsuccessful bidders suffer disappointment, distress and costs…  Am I wrong?  I invite rebuttal.  Let’s be evidence-based.

Take rural sanitation.  We have learnt a lot in the last decade:  the top-down building of toilets for people doesn’t work as CLTS (Community-Led Total Sanitation) has shown – people have to want to end open defecation, have to want toilets, and have to use them, keep them clean, and maintain and improve them; the astonishing spread of CLTS in African countries and elsewhere and its adoption by over 20 governments is evidence enough – despite problems common to all programmes that go to scale it is dramatically more cost-effective than earlier approaches, and this is well known in DFID.  But we all know that with good and enduring participation, you cannot predict speed.  Perversely there are evidently now targets, paid by results, for toilets.  Forced to achieve targets for payment after results, organisations may have to choose: abandon participation and do what they know won’t work, or go bankrupt, or lie (well, massage facts, gloss realities, mislead, report on what was planned not learn from what happened…).  I know a participatory organisation with an excellent track record which is being bankrupted through one of these contracts: the senior management have had no remuneration for six months.  If it goes under, this will be a result of PbR, evaluators please note, and please ensure, DFID, that negative externalities like this will be identified, costed and reported in all evaluations of PbR.

The rise of PbR – to what end and at whose cost?

Standing back, let’s ask:  what is going on?  How far will this go?  At what gratuitous cost to people living in poverty, and diminished cost-effectiveness of our tax payers’ money?  Is this what we had in mind when we campaigned for 0.7 per cent?   For the obstacle course of development, are straitjackets now to be de rigueur?  Brave new world.   And who is accountable to whom?  There isn’t the faintest whiff of accountability to poor people.  Has that been utterly forgotten?  And how many aid managers have development field experience (and by field I don’t mean in other capital cities)? Do they confuse accountability – the words are similar – with accountancy?  DFID is proud of meeting its spending targets!  Who in DFID recognises that not spending budgets can be an indicator of participation and empowerment?  That it is good to save money? Who rewards those who save money or spend it slowly because they are empowering people through participation?

The perversities of PbR and related approaches are set to diminish value for money:

  • Misfit with complexity. PbR and fixed goals, targets, milestones misfit complexity, unpredictability, flexibility, adaptability. Strait jackets for obstacle courses? Less that is good will be achieved. The Secretary of State has claimed that ‘DFID is … becoming a world leader in pioneering innovative Payments by Results programmes for tackling complex development problems’ (my italics) It is precisely with complex development problems where PbR’s misfit is most stark and tragic, and worst value for taxpayer’s money.
  • Misleading reporting.  Incentives can be perverse incentives to report results. Shoddy work: do what the numbers demand, never mind sustainability, ownership, empowerment – you can’t measure those so easily.  Bias to the measurable. DFID  ‘ …being paid by results… (drives up) performance standards, management and measurement {sic]’.  Yet Andrew Naitsios, former head of  USAID said ‘ …those development programs that are most precisely and easily measured are the least transformational, and those programs that are most transformational are the least measurable’ (No surprise that infrastructure is so much the rage – it can be measured)
  • View of human nature.  ‘Incentives’, ‘incentivise’ – in PbR there is an unspoken implication that people working in ‘aid’ are doing it for the money  (an insulting view of what drives people in development NGOs and research).  That is not what motivates the vast majority of the people I know.  They work in development because they actually care and want to make a difference
  • Disbursement targets.  It is a matter of pride that DFID is ‘meeting its spending targets’. Spend the budget by the end of the financial year.   Get the money out of the door in time.  Tick.  But too much aid too fast is a widespread complaint from recipients.

I could go on. In the world of NGOs and research at least, and probably much more widely, the effects of PbR seem set to be cruelly perverse.

In any case, where is the evidence that PbR is better than alternatives? Until PbR is soundly evidence-based, while DFID may  be a world leader in payment by results, for aid to be cost-effective, and for the sake of people living in poverty, let there be no followers.  If DFID want to be a world leader, perhaps this could be in honest, insightful evaluation of PbR which goes deep into its externalities and  the realities of all who are affected.

Alternative paths to the PbR highway

And let us note that outside the DFID pot, there is another, thrilling, world evolving.  Last month I was at the biennial Development Cooperation Forum in New York, convened by the Economic and Social Council of the UN.  There was talk there of ‘trust-based inclusive partnerships’ ‘horizontal relationships’, ‘South-South collaboration’ and the sense of a new dawn, a re-recognition of the vital significance of relationships which are not distorted by power.

So in PbR, where is the understanding of people, of communities, of participation, of complexity, where is the listening, where are the relationships in this world sanitised of humanity, and of people, of the personal?  Read the wonderful book Time to Listen: hearing people on the receiving end of international aid (Anderson et al 2012) whose researchers listened to almost 6,000 recipients of aid.  And what did they say? They said they appreciated aid but would prefer not to need it.  They said it comes too much and too fast.  They said they want and need relationships with donors, face-to-face, but contact is rare, if ever, and then rushed. They said they had to divert time and energy from action to demoralising and misleading reporting and upward accountability.  Again and again, they point to hidden transaction costs….  And the Time to Listen researchers found that wherever there was a good initiative or project there was always a person.

To conclude:  To give better value for money, please DFID

  • radically simplify and streamline your internal procedures and free up staff time,
  • recruit many more staff with grassroots field experience and who understand development realities, and free them to be in touch with the rapidly changing realities outside their pot, and
  • put PbR on hold until a few examples can be evaluated in depth over time.

If you did these three things, you would indeed, truly, be leading the world.  And there is one more thing.  To deliver astronomical value for money (and without a business case) the Secretary of State could authorise the purchase of 2000 copies of Time to Listen and send them to all DFID staff.  As a starter, I am mailing her a copy.

Robert Chambers is a Research Associate in the Participation, Power and Social Change research team at IDS.

Read other blog posts from Robert Chambers:


World Toilet Day: ‘We can’t wait to improve sanitation’


Petra Bongartz???????????????????????????????

The 19th November is World Toilet Day. The World Toilet Organization created World Toilet Day (WTD) to break the deadly silence around sanitation and to raise awareness of the struggle of the billions of people in the world who still do not have access to adequate sanitation. It is a day to draw attention to the many challenges this brings to their daily lives and the dire consequences for their health and wellbeing. A day to encourage discussion about what needs to be done in order to tackle the sanitation crisis! It is a call to action, a call for everyone to get involved in changing behaviour and policy in order to end open defecation and thereby change the lives of billions of people for the better.  And it is also an occasion to recognise and celebrate the efforts and achievements of organisations and individuals in bringing about positive change in the area of sanitation and hygiene.

Woman standing outside a latrine in Malawi

Latrine in Malawi, photo by Edson Baptista

This year, the first year of the 19th November being officially designated World Toilet Day by the United Nations (despite it having been ‘unofficially’ honoured since 2001), the theme is ‘We can’t wait to improve sanitation’.  And with 2.5 billion people around the world still lacking appropriate sanitation, the call for action is as urgent as ever!

The Community Led Total Sanitation (CLTS) Knowledge Hub at IDS is marking the occasion with the launch of a new publication series Frontiers in CLTS: Innovations and Insights – a series of short notes offering practical guidance on new methods and approaches and thinking on broader issues. The first issue looks at participatory latrine design. A methodology that can ensure that users participate in creating and selecting sanitation technologies that are appropriate for their needs.

Petra Bongartz is the Coordination, Communication and Networking Officer for the Community Led Total Sanitation (CLTS) Knowledge Hub, based at the Participation, Power and Social Change Team at IDS.

Read more about CLTS:

‘The power is in your hands’ – Global Handwashing Day and Community-Led Total Sanitation


Susanne SchirmerSue_Schirmer200

Together with improved sanitation handwashing with soap is one of the most effective and inexpensive ways for preventing diarrhoeal, acute respiratory and other infections, which take the lives of millions of children in developing countries each year. The 15th October is Global Handwashing Day and each year about 200 million people are involved in celebrations in over 100 countries around the world. My colleagues from the Community Led Total Sanitation (CLTS) Knowledge Hub at IDS are marking the occasion by promoting handwashing-related publications and resources on the CLTS website.

CLTS is an innovative methodology for mobilising communities to completely eliminate open defecation (OD). Communities are facilitated to conduct their own appraisal and analysis of open defecation (OD) and take their own action to become ODF (open defecation free). Handwashing is very much part and parcel of the CLTS approach, as Robert Chambers explains in this online discussion: ‘Handwashing is widely included in triggering or comes soon after. There are ways in which this is facilitated which are not didactic … The main one is likely to be – (if you don’t wash) – the realisation that they are eating their own shit.’

girl washing her hands

‘The Power is in your hands’ photo by Petra Bongartz

There are some innovative ways of triggering handwashing behaviour which UNICEF Malawi researched and collated in this ‘How to Trigger Handwashing with Soap’ Guide – some, for example the ‘scratch and smell method’, are not for the faint-hearted: The facilitator puts his hand inside his trousers and (pretends or actually) scratches his bottom. He then offers his hand to community members to shake. If, as is likely, they recoil and refuse, a discussion on why ensues and leads into conversations about the importance of handwashing.

Visit the CLTS website to find out more and access a number of resources relating to CLTS and handwashing or visit the Global Handwashing Day website to find out about the celebrations around the world.

Sue Schirmer works as Communications Coordinator for the  Participation, Power and Social Change (PPSC) team at IDS. The Community Led Total Sanitation (CLTS) Knowledge Hub is hosted at the PPSC team at IDS. Visit the CLTS website to find out more or follow their blog posts

Read other blogs relating to CLTS

Sanitation and Hygiene: Undernutrition’s Blind Spot


Robert Chambers

The undernutrition of babies, infants and children is horrible and a disgraceful blot on our human record. It is not just the immediate suffering, anguish and death. It is also the lasting impact: when growth is stunted at age 2 the damage is largely irreversible. Stunted children are disadvantaged for life – their cognition and immune systems impaired, and their education and earning prospects reduced. Stunting leads to a 10 per cent decrease in lifetime earning. Stunted children start school 7 months later and attend 0.7 years less than children who aren’t stunted.

So undernutrition cries out for action and there is plenty of action. The normal, commonsense, humane response is direct and visible – to get more nutrients and food into babies, infants and children. To get it into their mouths. Who could be against that? Not me. It is so obvious, so necessary, so important, so urgent, with such immediate results.

But, and it is a monumental but, has this distracted attention from a major cause, and outside famines and acute seasonal crises, I will dare to venture even the main cause: faecally-related infections(FRIs)? Have I lost my senses? Well….

I recently watched  a video of a presentation made by Dr Jean Humphrey in India, and met her, and heard her speak  at the UK Department of International Development (DFID). She works in Zimbabwe and in the Lancet (19 September 2009) famously argued with convincing evidence that environmental enteropathy (EE) is a more significant cause of undernutrition than diarrhoea. EE is a persistent subclinical condition in which infections damage and reduce the absorptive capacity of the gut and at the same time make it permeable so that nutrient energy has to be continuously diverted to make antibodies to fight the infection. EE is a multisystem disorder, a ‘profound immune system disorder’ which moreover weakens the immune system later in life. That Lancet article stirred things up, and she is now engaged on long-term rigorous field research into EE. She and others are now saying that diarrhoea is just the tip of the iceberg. I agree. But what an iceberg, not just EE!

Here are some bullet points. Are they right?

How significant are the diarrhoeas as causes of undernutrition?

  • Because among faecally-related infections, they are so dramatic, awful, visible and episodic, and so easily measurable, the diarrhoeas have received and continue to receive the major professional attention. Many other conditions are subclinical, continuous, invisible and hard or impossible to measure. The multiple dimensions of EE are a very significant part of this.
  • With oral rehydration therapy, diarrhoeas are less damaging than they were
  • There is rapid recovery between bouts of diarrhoea
  • Studies of the effect of diarrhoeas on linear growth show effects in the range of only 5-20 per cent, and some show none at all
  • In the Gambia where the Dunn Nutrition Laboratory has been doing research for many decades there has been a big drop on the incidence of diarrhoea 1979 – 1993 but no change in stunting. They have found stunting is not explained by inadequate diet or days of diarrhoea!

The misleading conclusion could be drawn that since diarrhoeas are not so much implicated in undernutrition, sanitation and hygiene are not so important either, and that FRIs in general are not so signficiant

Feeding programmes
What is the evidence of the impact of feeding programmes?

  • A review of 42 studies of feeding programmes found that the very best solved only one third of the problem and some had no effect at all
  • No nutrition intervention has ever normalised linear growth

Faecally-related infections (FRIs)
FRIs are much more than the diarrhoeas and EE.

  • The variety and scale of these infections is quite mind-blowing. There are intestinal parasites – bacterial like gardia (extremely widespread), amoebiasis, and worms like ascaris (1.5 billion infected) that steal food and hookworm (over 700 million infected, 200 million in India) which voraciously consumes blood from the host, and tapeworms which come through intermediate hosts. There are hepatitis A, B and E, typhoid fever, polio and other enteroviruses, schistosomiasis (over 200 million, more than half in Africa), liverfluke, trachoma, and various zoonoses from animals (in addition to tapeworms)…..

So there is much, much more to the iceberg of which the diarrhoeas are the tip, than EE. No one so far has been able to point me to a study of how many of these infections are found in any one undernourished infant or child, nor how they interact. So my question to those who work in nutrition and those who work on faecally-related infections, is this: does professional specialisation prevent us seeing the enormity of the whole picture? And is the implication of the whole picture that sanitation and hygiene are not only a huge priority in eliminating undernutrition but even, bar famines and seasonal crises, possibly the main means?

Consider India. The latest data indicate that India has 59.4 per cent, almost three fifths, of the open defecation in the world, a proportion which has risen in the past decade. It also has a third of the undernourished children, a figure which has largely resisted herculean attempts to tackle it directly through the mouth with school meals, ration cards and the like. Imagine if suddenly all FRIs were caught and confined safely just below the anus. How much undernutrition would remain?

Robert Chambers is a Research Associate in the Participation, Power and Social Change research team.

Read other recent blog posts from Robert Chambers:
Ensuring those who are ‘last’ come first: using Reality Checks to inform post-MDGs
Discrimination, duties and low hanging fruit: reflections on equity in CLTS
A passionate family: reflections on the WSSCC Global Forum on Sanitation and Hygiene

Ensuring those who are ‘last’ come first: using Reality Checks to inform post-MDGs


Robert Chambers

The MDGs picked low hanging fruit.  To achieve them,  the incentive has been to go for those who were closest to thresholds or easiest to help, for instance people close to the poverty line, those who are most accessible and so on.   But this precisely leaves out the last, those who are poorest, least able, most marginalised, women most vulnerable to maternal mortality and babies most likely to die.  What this has meant can be shown by UNICEF’s diagram of sanitation in India.  The  Total Sanitation Programme of subsidised toilets was meant for those below the poverty line, roughly the bottom two quintiles.  But they hardly gained at all.  The biggest gains were by those already better off, the third and fourth quintiles.

Let me propose, and add my voice to others who are proposing, that post-MDG the great need and opportunity is to think and act from the other end, with those who are poorest, weakest, and most excluded and marginalised, those who are disadvantaged and lving with physical, mental and/or social disability.  It means aiming to level up from the bottom with equity as the goal and a radical rethink of policies and priorities.

It also means reviewing and focusing systems of monitoring and learning.  Policy-makers need to be closely in touch with what is happening on the ground to those who are worst off, the conditions they experience and their changing realities. It means finding ways in which there can be flows of honest, accurate, insightful and credible information to those in positions of power. This matters more than ever given the rates of change for all people living in poverty, not least with the rapid transformations of global interconnectedness, the mobile phone revolution, and accelerating changes in social conditions and relationships.   Being out of touch and out of date has always been a problem, and has repeatedly led to misfits between policy and field realities.   More than ever before, those in capital cities are finding it challenging to keep up with developments and changes at the grass roots,. This can be expected to be even more pronounced after 2015.

Fortunately, we have a new means for being in touch and up-to-date.  An approach has been pioneered which all countries can and should adopt.  This is the Sida-supported Reality Checks pioneered in Bangladesh.  This is a brilliant and extraordinarily successful innovation.  Many have still not heard of it, but it is beginning to be recognised and spread.  

The Reality Checks are conducted annually at the same time of year by the same teams.  Outsiders spend several days and nights staying in the homes of people living in poverty. Each year they stay with the same families in the same nine representative areas.  The brief for those who take part in Bangladesh is to listen, observe and understand the perspectives of their host families and others in their communities. The focus has been primary education and primary health care, two sectors which Sida supports, but a great deal else has come to light.  The approach lends itself very well to learning about the realities of those who are poorer, weaker and most marginalised.

The insights repeatedly surprise, not least people’s changing experiences, behaviours and priorities. Unrecognised policy issues are raised. Much more is learnt than just about education and health.  The teams have been struck, even astonished, by how much has changed and how fast it has changed since the first Reality Check was conducted in 2007.   The people who live in poverty in all countries deserve that their governments keep themselves in touch in this sort of way. 

A bottom up focus on equity and on those who are ‘last’, and the approach of Reality Checks, combine and support each other well. Emulating Bangladesh, they could and in my view should be adopted and adapted by all governments.  David Cameron could set an excellent and early example by starting Reality Checks in the UK. Though his stay was brief, the Secretary of State, Andrew Mitchell, can testify to the value of staying overnight in a community from his own experience with a poor family in Ethiopia.

We do not need to wait for 2015.  We could start now.  Experience could then be gained across a range of countries and conditions, ready to inspire and inform extensive adoption post 2015 and to make it more feasible for equity and the wellbeing of those who are ‘last’ to come first.

Robert Chambers is a Research Associate in the Participation, Power and Social Change research team at IDS.

Discrimination, duties and low hanging fruit: reflections on equity in CLTS


Robert Chambers

The equity day at the WSSCC Global Forum in Mumbai (October 2011) made a deep impact on me.  I am ashamed to admit this.  I should not have needed this. I have been banging on about ‘putting the last first’ for years, but the fuller implications of this with sanitation only came home to me on this day. Thank you those who came and shared their experiences with us –rehabilitated manual cleaners, slum dwellers, disabled, minorities… and Louisa Gosling, Archana Patkar and Nomathemba Neseni and who pulled scales from my eyes.

I am not proud that when sanitation as a human right first came up, my enthusiasm was muted.  I was so imbued with the CLTS (Community-Led total Sanitation) philosophy of no hardware subsidy and of people digging their own pits and making their own toilets that I feared that a rights focus would encourage dependent attitudes and undermine CLTS.  People might demand that government provide them with everything. Well, how wrong can you be?  It depends how you see rights. Frame them differently and  you can see that poor rural people have a right not to be marginalised by top down standardised hardware subsidy programmes like the Total Sanitation Programme in India, in its usual and classic form. Instead they have a right to be facilitated, to be enabled to do their own appraisal and analysis and collectively come to recognise the gruesome reality that they are ‘eating one another’s shit’ and decide to do something to stop it.  Before the equity day, that was about as far as I had got.

What hit me on this day went further. The pieces were shaken up and settled to fit in a new pattern.  We have rights-holders, to be sure.  But we also have duty-bearers.  And we are duty-bearers. But how are our duties determined? They have been defined in terms of the Millennium Development Goals (MDGs), of building up from the base, of filling the empty glass fuller, of achieving targets.  But even achieving the MDG targets would leave hundreds of millions of people still without even the most basic sanitation, still without hygienic behaviour, still suffering the multiple deprivations of Open Defecation (OD) and the horrendous and often cumulative debilitations and sufferings of multiple faecally-related infections.  Not only that, but what does striving for the MDGs in sanitation imply? It implies going for the easy ones, picking the low-hanging fruit. That’s how you achieve targets (or minimise shortfalls).  And that implies neglecting, leaving out, not serving, the more difficult, more challenging, and more deprived ‘last’ whose need is so often greater.  For achieving targets, those who are last are not cost-effective.

And who are these last?  Well, the UNICEF quintile bar charts show how the poor and rich compare: and among these, the charts for India are a stark and shocking indictment of a decade of programme failure on a mega scale: the last who were meant to be served –like the bottom two quintiles – have been barely touched. Then consider who these last are.  Someone said that half of humankind are in some way disabled or specially vulnerable.  I found that difficult to believe until I began to think it through.  Consider who they include: the very poor and destitute; those with the many forms of physical or mental disabilities; people living with HIV/AIDS; those who suffer discrimination – sex workers, LGBTs, low status minorities…; those exposed to and living in insanitary slums and other ‘places of the poor’;  migrant workers, refugees, internally displaced people, and other distress migrants; the chronically sick; and more and more, the infirm aged (unable to walk or walk far, unable to squat…) who are a growing proportion of humankind.  And then, what about vulnerable children?  And all this before considering discrimination against females, or menstrual hygiene. There are shocking answers to questions too, questions I had not asked myself.  How do blind people manage with OD?  Or people who have to crawl? Do they have to go where others go?  Do they get the stuff on their hands? How do they clean up?

As long as any of these ‘last’ are exposed or deprived in such ways, and lack proper access, are we as duty-bearers discriminating by default?  That was the question Archana threw out at the end.  And it will not go away.

So I am in a new space.  With renewed anger.  And asking what the implications are for CLTS. Two stand out straight away. First, with rural CLTS, triggering and/or early follow up must be facilitated so that people identify the ‘last’ in their communities and what needs to be done that they cannot do or be expected to do for themselves.  For the poorer and less able this is already standard good practice but it must go further, and identify those who face physical and other disabilities, encouraging local actions and innovations to provide what is needed.

Second, with urban  Citizen-Led Total Sanitation, when full or even partial self-provision is not an option, rights-based demands, mobilising to secure support and services from the authorities, has to be a major part of the way forward.

So thank you WSSCC for the equity day and for the whole Forum, and roll on the next; and by then let’s hope we will have seen big shifts with many actors and champions – in communities, in governments, in NGOs …- turning the MDGs on their heads to put equity first by starting with the last.

Robert Chambers is a Research Associate in the Participation, Power and Social Change research team at IDS. . This piece will feature in a forthcoming publication by WSSCC, entitled “WSSCC Global Forum on Sanitation and Hygiene: Insights on leadership, action and change”.