A Promise, and Pitfalls

AfricaMalariaDiseases and IllnessesHealthPoliticsDeathForeign Aid

President Bush's announcement last week of a $1.2-billion package to fight malaria in Africa over the next five years showed an awareness of the disease's economic and human toll. That's progress; the United States has essentially ignored its devastating effects on Africa for decades, throwing in token sums that have enriched U.S. aid contractors but done next to nothing to reduce mortality from a plague that kills from 1 million to 3 million people a year.

Speaking at the Smithsonian Institution on Thursday, Bush announced a package of aid for Africa that also included a doubling of U.S. spending to $400 million for promoting education for girls and an additional $55 million over three years to improve legal protections for women. Welcome moves all, but also a defensive strategy. At the Group of 8 summit starting Wednesday in Gleneagles, Scotland, Bush will be asked to join an initiative by British Prime Minister Tony Blair to double overall aid to Africa. Bush now has a face-saving way to turn Blair down.

All that aside, Bush's malaria initiative is an inspirational commitment that — if implemented properly and fully funded by Congress — could save thousands of lives. Unfortunately, those are big "ifs."

Bush has made grand promises before on foreign aid but failed to wield his influence over the Republican-controlled Congress to get them funded, or to follow through to get the money used.

His biggest aid initiative, the Millennium Challenge Account, was initially touted as a sweeping commitment to Africa that would rise to $5 billion a year by 2006. For the 2006 budget, Bush requested $3 billion for the account, and last week a Senate subcommittee trimmed that to $1.8 billion. The previous year's commitment was less. Yet even that is misleading. To date only $400,000 from the account has actually been spent, though commitments have been signed to spend $610 million on four nations.

Assuming Bush can drum up the money to keep his $1.2-billion promise on malaria, there are serious questions about how it would be spent. At all costs, the administration should resist the traditional method of distributing foreign aid: giving it to the U.S. Agency for International Development.

In May, Senate hearings on USAID's anti-malaria spending turned up some shocking revelations, including the fact that just 5% of the agency's $90-million malaria budget is spent on concrete tools to fight the disease, such as insecticide-treated bed nets and drugs. The bulk of the money goes to nonprofit U.S. corporations that mostly provide high-priced consulting work to African governments or create public education campaigns to induce people to buy bed nets, which very few rural Africans can afford.

The administration promises to work with other governments and the Global Fund to Fight AIDS, Malaria and Tuberculosis, and that's a good sign. Bush should see this initiative as an experiment in distributing aid without USAID's involvement.

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