KAMPALA: The health clinic in Buikwe, Uganda, has no doctor, insufficient medicines, crumbling infrastructure, and a monthly budget of $150 to treat 33,000 people.
It has an HIV-positive caseload of about 3,000, and there were 40 confirmed malaria infections on the day I visited alone. Malaria remains the top killer in the district, even though it costs only one to three US dollars to treat.
Women and children routinely die in childbirth. The choice is between a dangerous birth at home and giving birth on a mattress that’s falling apart (but in the care of a good midwife) at the clinic.
As I drove out of the clinic the news hit my phone that President Trump had released his budget proposal, suggesting deep cuts to US foreign assistance to places like Buikwe.
This sort of support is not a ‘nice to have’. When the difference between life and death still hangs in the balance over a $1 treatment, the US can’t afford not to provide a basic minimum of live-saving aid abroad. People may say ‘let’s build bridges at home’, but there is no argument that can seriously compete with the power of a few dollars that utterly transforms lives.There is no argument that can seriously compete with the power of a few dollars that utterly transforms lives.
And while I’d like to think that such basic moral and utilitarian arguments are enough, it’s profoundly important to recognise the loss of power, prestige and security that such short-term thinking portends.
For decades, the US has operated around the world as the go-to nation in a crisis – not by virtue of its military power, but by its sheer ability to respond first, with the greatest resource.
This is true in places where the US has great, long-standing partners – like responding to Ebola in Liberia or an earthquake in Nepal. But it’s also true where such a response can improve relations, like supporting the typhoon response in junta-led Myanmar, or floods in Pakistan.
With the world facing up to four famines this year, an unprecedented refugee crisis, and threats of a global economic slowdown, the cuts to humanitarian aid, family planning, and assistance that helps poor countries to grow is completely out of touch with US economic and security objectives.
This belief is backed by strong bi-partisan consensus. As Republican Senator Lindsey Graham said yesterday, ‘If we implemented this budget, you'd have to retreat from the world or put a lot of people at risk.’
And despite the challenges facing places like Buikwe, I heard good news in Uganda too. Aid works.
The anti-retroviral drugs needed to combat AIDS are in good supply, thanks to US assistance, and infection rates are falling. Pre- and post-natal care are up and mortality rates falling with support from USAID and its British counterpart, DFID. Overall, eight million Ugandans – 20% of the entire population – have emerged from crushing extreme poverty in the last decade.Uganda is increasingly self-sufficient, raising and spending more of its own resources effectively.
And Uganda is increasingly self-sufficient, raising and spending more of its own resources effectively. We know this for a fact due to efforts like ODI’s Budget Strengthening Initiative, a partnership with the governments of fragile and conflict-affected states that has vastly improved transparency in countries like Uganda.
In the end, a bipartisan consensus of moderate senators will likely prevent a catastrophe. ‘This budget is not going to go anywhere,’ according to Senator Graham.
But don’t think this is a numbers game. The ideas in the Trump budget will have profound negative consequences at home and abroad.
Alex is in Uganda and Kenya this week looking at what’s working to address some of our biggest development challenges. Follow him on Twitter at @Thieristan.