A few years ago I attended a high level meeting for a large and well respected international health organization (one that I also high respect, so it shall remain nameless) in Africa. I generally sat in the back, mostly because one was likely to secure a power cord back there. Nearly every day I sat next to the same woman, who from her clothing appeared to be from that location. We never really spoke but occasionally we would exchange glances throughout the conference.
One day we ended up in the lunch line next to one another so I decided to strike up a conversation with this woman. Turns out she could not understand a word of English. I tried French, again not a word. I wondered to myself “if she does not understand English or French, what has she been doing in the room with us for the past few days?”. When I told this a colleague who had been to many of these conference he had a quick answer – “she is there for the per diem – her sitting fee.”
I was horrified that this type of behavior was happening at a meeting of this nature. There was a whole section of people in the back of the room, it turns out, who were all there for the sitting fees.
Anyone who has conducted work in Africa has certainly encountered the per diem culture. There are endless meetings and trainings, sometimes it seems they are organized for the sake of the per diems. While certainly one would expect people to get compensated for their travel and their additional expenses, I believe the practice has gotten out of hand.
In Ethiopia where I spent most of the month of June, I recall one health official telling me that they had to put a limit on the practice because donor organizations were out bidding one another with higher and higher per diem rates and in the end they could not control the whereabouts of their employers. The HIV organizations were frequently in violation of the limit, so now they have given a special exemption for HIV.
In a recent essay, Andrew Jack of the Financial Times argues that the per diems are at the root of many of the problems of slow bureaucracy in health services. He calls them:
“..a form of institutionalised, legal time-wasting that is endemic in the region – and an unwelcome global phenomenon legitimised by donors and international organisations alike.”
I challenge those out there who are opposed to funding cuts for HIV in Africa to ask whether existing resources are being used effectively as well. I suspect much of it is wasted and much more could be done within the existing financial envelope if we took a closer look at how money is currently being spent and what impact it is having.Share on Facebook