Bill Gates is the latest person share his thoughts about famed development economist Jeff Sachs. His review of the book The Idealist by Nina Munk, which contains a rather unflattering portrayal of Sachs, outlines why he is a fan of Sachs, but thinks Sachs is also wrong. Gates argues that Sachs’s Millennium Villages Project lacks the long term financial support to sustain improvements.
“Through that rear-view mirror, we can see that the project didn’t have an economic model that could sustain successes once the MVP dollars ran out. All of the interventions involved – health, agriculture, infrastructure, education, and business seed money – make sense if carried out carefully, over time,” writes Gates.
His review sparked the Columbia University professor to challenge the philanthropist. Sachs is the brains behind the oft-debated Millennium Villages Project (MVP), an effort to lift communities out of poverty through connected improvements from health to agriculture to education.
So let me take this opportunity to reiterate a challenge that I have posed to Bill. He can pick any district in rural Africa, and our team will work with the local communities using the Millennium Village health approach to reduce the under-five mortality rate to below 30/1,000 – a rate characteristic of many middle-income countries – at an annual health-sector cost of just $60 per person. And we will do it in five years or less. That success, I believe, would help Bill and others to recognize the remarkable value of investing in low-cost rural health systems that follow the design principles of the Millennium Village Project.
In 2012, Sachs and his colleagues published a study on data collected from the Millennium Villages across sub-Saharan Africa touting the success in reducing childhood stunting and mortality. It claimed in part “the average annual rate of reduction of mortality in children younger than 5 years of age was three-times faster in Millennium Village sites than in the most recent 10-year national rural trends.”
According to the MVP researchers, child mortality fell by 7.8% each year. The data published did not back up the claims. It was quickly pointed out that the averages were taken at the wrong point in the data set. Such a shift saw the the average rate of decline decrease to 5.9%, similar to that of national averages. Sachs and company took credit for reducing child deaths at the very same rate it was going down everywhere else.
That does not make for a strong argument that the MVP’s were the cause for the reduction in child mortality. It is just as possible that changes at the national level and overall improvements were behind fewer children dying.
That brings us back to the development bet put forward by Sachs. He does not call it a bet, nor is there a wager, but it is the same rhetorical device. Either way, the challenge by Sachs is meant to say that he is willing to prove that he is right, knowing full well that Gates will not take up the offer. Neither of the two men really want to start an MVP in a village on a bet. It would come off much like the bet in the 1980’s classic Trading Places, two white guys testing their theories on poverty.
Gates uses The Idealist to support his criticisms of the MVP. He explains, in part, why he did not provide funding to the project while making sure to heap praise on Sachs wherever possible.
My colleagues and I had a number of concerns about Sachs’s approach. We questioned his assumptions about how quickly the gains would materialize, what would happen when the MVP funding was phased out, how much governments would contribute to offset the high per-person costs, and how feasible it was to measure progress (given the likelihood that people from the surrounding area would stream into their villages once the MVP aid started flowing). So we decided not to invest in the MVP directly.
Fortunately, there is no need for the gentleman’s wager. A new MVP in Ghana is going to be independently and rigorously evaluated by the UK’s Department for International Development. It will give some better insights to what is happening within the project, but it will not allay concerns. Critics say that throwing a lot of money in a community will cause some things to get better. They will likely quibble with any positive findings from the Ghana evaluation because of this very point.
For their part, the MVP and Sachs say that it is difficult to single out what things are causing change. The very point of the MVP is that change has to take place across everything at once, not a single area. Health will improve because people are getting better health services, eating better food and increasing their incomes. All of these improvements will feed into each other, thus lifting people further out of poverty.