Blind Spots, Politicisation, and PlayPumps
Blind Spot by Salmaan Keshavjee explores the privatisation of healthcare in Badakhshan after the collapse of the USSR (Keshavjee, 2014). In particular, Keshavjee considers how the non-governmental organisation (NGO) Aga Khan Foundation (AKF) implemented healthcare support, which resulted in “…the transformation of health care in the region from a universal, socialised system to a privatised apparatus guided by the priorities of donors from abroad” (Keshavjee, 2014, p. 3). In this paper, I will examine the ideas Keshavjee (2014) presents about NGOs, and how they often become a vehicle for implementing neoliberalism and the “ideological agenda” of Western states (p.7). I will explore the failed NGO initiative, PlayPumps, through this lens, considering why it is a challenge to criticise the work of NGOs, as well as sharing the perspectives of other critical scholars on the role of NGOs in the politicisation of their beneficiaries.
Keshavjee shares the story of dentist Misha, who approaches AKF requesting a grant of $500 to keep his dentist clinic open and providing free treatment for the community (Keshavjee, 2014). AKF provided Misha with a loan instead. In this one quick move, his clinic became privatised, and he needed to charge for his treatments to repay the loan (Keshavjee, 2014, p.114). Keshavjee explores how the revolving drug fund was implemented in Badakhshan in 1996, regardless of whether it would work or people wanted it “because it was seen as a way to transition from humanitarian assistance to some form of sustainable development” (Keshavjee, 2014, p. 113). Here, Keshavjee (2014) claims the privatisation of healthcare took place when “ideology was operating as common sense” resulting in what he referred to as “neoliberal programmatic blindness” where the ideological objective of a programme had taken over (p.114).
This criticism is also explored by Naz Rassool (1999) in her literacy for sustainable development analysis. Rassool criticises some literacy NGOs as “positioned within particular ideological frameworks” which can lead to the politicisation of community members without improving communities (Rassool, 1999, p.91). This politicisation occurs because some NGOs position themselves against government policies in the region they are acting in, accountable to their funders and seeking to fill the gaps left by government policy (Rassool, 1999). Consequently, this can lead the beneficiaries of NGOs to become “highly politicised” (Rassool, 1999, p.14). It also results in a conflict of priorities between locals, like Misha, and the consultants who have been brought into the area by the NGO, like Keshavjee. I argue this politicisation can be seen in Badakhshan in the story of Misha, who was a beneficiary of AKF. Despite Misha being unable to treat patients that cannot afford the new clinic prices after the loan implementation, he still believed privatisation was the only way forward (as cited in Keshavjee, 2014). David Scott (2004) would argue Misha was a conscript of modernity, an “outcome” of a “colonial encounter”, who had no alternative but to become part of the neoliberal system (p.191).
While Keshavjee provides an interesting analysis of Misha’s politicisation/conscription and AKF’s implementation of a neoliberalist agenda, his research is nothing new when published in 2014, although his book was. Afterall, Rassool was drawing similar conclusions in 1999 by arguing neoliberal international organisations claimed to use the tools of the Western world to ‘solve’ the issues of ‘development’:
“[literacy] is still presented…by UNESCO, the World Bank, the IMF and countless ‘aid’ organisations as a panacea which will solve all ‘development’ problems” (Skutnabb-Kangas as cited in Rassool, 1999, p.vii).
However, what Keshavjee does provide is an interesting example of how neoliberalism can be imposed on beneficiaries of an NGO, regardless of whether the objectives of that NGO’s initiative are successful. The material explored in Blind Spot was observed over twenty years ago but published in 2014 and fails to offer a current update of the situation in Badakhshan after AKF intervened. Arguably this missing update is because Keshavjee does not feel the analysis requires one, as the outcomes of imposing neoliberalism on beneficiaries of AKF are apparent in the original research. For example, Misha agrees with the privatisation of the hospital clinic; thus, neoliberalism is imposed on Misha and his community. Still, I wonder if the privatisation of healthcare resulted in gaps in the healthcare provision in Badakhshan in the longer term? Did medicine black-market and backstreet health clinics develop for those who struggle to afford healthcare prices? Or did AKFs intervention led to a catastrophic collapse of healthcare provision?
Another reason Keshavjee may not provide these more recent observations is because of the challenge faced when questioning the reputation and actions of a predominantly highly successful NGO. Keshavjee said of this:
“The first was a concern that publishing this work would impugn an organisation that I both admire and respect. I was worried that it would detract from the hundreds of successful projects that AKF has implemented over the years in so many countries, improving the wellbeing of many” (Keshavjee, 2014, p.16).
When exploring this challenge, I was reminded of PlayPumps. In the PlayPumps initiative, an NGO installed children’s play roundabouts in villages in Mozambique to act as a tool to pump more water to the local area. As children would play on the roundabout, it would pump water to the village. The idea was backed by celebrities like Jay-Z, Beyoncé, and Justin Timberlake, and it gained an international reputation as a transformative idea (Murphy, 2013). PlayPumps was initially considered a great success because the NGO entered a ‘developing’ nation that needed a better solution to its water provision and transformed the lives of those living there. This alleged transformation resulted in Jay-Z, a significant financial backer of the initiative, being honoured in 2008 by the United Nations for his contributions to PlayPumps.
However, as testing would later reveal, the PlayPumps solution was a catastrophic failure. The initiative failed because the solution provided was not suitable from an engineering perspective. Moreover, the moral implications of having children play for water are questionable, too, but remained unchallenged until PlayPumps’ failure. A final reason for failure is a concern, also echoed in Blind Spot, that the “appropriate role of development agencies and philanthropic foundations” (Stellar, 2010, paragraph 3) were not adequately understood and so a solution was provided which did not fit the needs of the local area. In Blind Spot Keshavjee does not imply local people were engaged in the dialogue about the solution for their healthcare. Not including local voices was also a problem with the PlayPumps initiative and many other NGO initiatives globally; they are led from the West and often fail to engage the local community in the solution. For PlayPumps, this meant when the pumps broke down; no one knew how to fix them.
Symbolically, the PlayPumps failure illustrates the interconnection between technology as a tool of wealthy states in development initiatives that are delivered in a top-down method. This top-down method is a broader issue with technology. In technology, technical tools are developed by mostly “white guys” considered “the best and the brightest” and their tools are considered “magic” because they are not adequately explained to the masses (Wachter-Boettcher, 2019, p.9). It serves the technologists, and the corporations they represent, to maintain this mystery and power imbalance around their creations because it means they can continue “keep doing whatever [they] want” without facing public scrutiny (Wachter-Boettcher, 2019, p.9).
This parallel of ‘doing whatever you want’ and lack of transparency can be seen in the ongoing development initiatives by China in Nigeria; another ‘blind spot’ that has a limited infrastructure. In Nigeria and other African nations, China is investing heavily in the development of railways and airports, leading to concerns about debt and forced asset-swaps (Feng, 2018). Still, once these development projects start, they are almost impossible to stop due to the “economic clout” China possesses (Feng, 2018, paragraph nine). Again, this is an example of top-down development where the actor providing the development holds the power and fails to engage local people in the dialogue. Yet, this type of development is permitted to continue anyway because of that power imbalance, or perhaps, ‘magic’. Thus, China and other states can ‘keep doing whatever they want’ under the heading ‘development’.
In Blind Spot, Keshavjee explores the privatisation of healthcare, referring to it as a ‘transformation’. PlayPumps were also supposed to be a transformation of the provision of water to villages in Mozambique. These alleged transformations encouraged me to think about the role of ‘transformation’ in the NGO and ‘sustainable development’ arena; ‘transformation’ also appears in the 2030 Sustainable Development Goals (UN, 2019). To transform something suggests a total overhaul of the current system and approach:
Perhaps the focus should have been innovation instead of transformation in the case of PlayPumps and AKF. Innovation implies using a new system or method but within the existing framework (Cambridge dictionary, n.d). The jugaad “hack” (Rai, 2019, p.ix) or “‘frugal’ form of innovation” (Wylie, 2012, paragraph one) may have been more suitable in the Badakhshan case. Rather than a drastic overhaul of what already exists, Misha and his patients in Badakhshan may have received better results if AKF provided the grants they had in the past, rather than a loan. Using this grant, Misha could have developed his version of a jugaad ‘hack’ or ‘innovation’ to overcome what was broken, engaging in the “strategic multiplicity” of jugaad (Rai, 2019, p.55), rather than contributing to the full system overhaul of privatisation.
The use of transformation vs innovation encouraged me to think further about whether the language of sustainable development in emphasising transformation, is also the language of neoliberal ideology. After all, neoliberalism requires a transformation, not innovation, of the market and individual values where “inequality is recast as virtuous. The market ensures that everyone gets what they deserve.” (Monbiot, 2016, paragraph 4). Amit Rai’s (2019) argues jugaad is perceived as “the result of the high-risk habits of the incorrigibly precarious”, rather than the “light-bulb” moments of innovation (p.20). The practice of jugaad is “the enemy of sustainability” as it is too frugal, resulting in inadequate solutions, and is, therefore, an “obstacle to security and trust” (Rai, 2019, p.21). Jugaad is an interesting parallel to the language of sustainable development too, where transformation is favoured over innovation. Now, in the eyes of the neoliberalist agenda, a total overhaul of the system is required.
In conclusion, Keshavjee encourages the reader to explore the shift of patients to customers and healthcare providers to healthcare businesses in the Badakhshan region:
“…a rich treasury of ethnographic material on the consequences of abrupt, radical privatisation, supported by bilateral and multilateral institutions with mandates largely framed by the discourse of neoliberalism and implemented amid profound social upheaval and transformation” (Keshavjee, 2014, p. 8).
As a former NGO employee, the book encouraged me to reflect on the challenges of the work of NGOs. NGOs usually fill the gaps the government has failed to in some of the most difficult environments. However, in doing so, NGOs often “inadvertently participate in expanding the penetration of neoliberal ideology” (Keshavjee, 2014, p. 8). In this paper, I draw on the literature of Rassool, who questions the effectiveness of some literacy NGOs that have caused politicisation in their beneficiaries, through standing against the government policies of the area they are operating in and aligning with the values of their key donors. NGOs are often accountable to their donors, and so this can result, as Rassool argues, in ineffective initiatives and beneficiaries who are ‘highly politicised’ by the NGO. PlayPumps is an interesting example of an NGO’s project failure, which was implemented despite a lack of testing and consideration of who the initiative was designed to benefit. This lack of testing can be a considerable challenge in NGOs, as people seek to make positive change and help others, which can lead to a lack of scrutiny about what success looks like and for whom. Arguably, this can be seen in AKF’s policies too, and specifically in the story of Misha, who was committed to a loan despite just needing a $500 grant.
- Cambridge Dictionary. (n.d) Definition of Transformation. https://dictionary.cambridge.org/dictionary/english/transformation
- Cambridge Dictionary. (n.d) Definition of Innovation. https://dictionary.cambridge.org/dictionary/english/innovation
- Feng, E. (2018, November). Chinese investment extends its influence in Nigeria. The Financial Times. https://www.ft.com/content/14f5438e-c32b-11e8-84cd-9e601db069b8
- Keshavjee, S. (2014). Blindspot: how neoliberalism infiltrated global health. The University of California Press.
- Monbiot. G. (2016, April 15). Neoliberalism: the ideology at the root of all our problems.” The Guardian. https://www.theguardian.com/books/2016/apr/15/neoliberalism-ideology-problem-george-monbiot
- Murphy, T. (2013, July). How PlayPumps are an example of learning from failure. Humanosphere. http://www.humanosphere.org/basics/2013/07/how-playpumps-are-an-example-of-learning-from-failure/
- Rai, Amit S. (2019). Jugaad time: ecologies of everyday hacking in India. Duke University Press.
- Rassool, N. (1999). Literacy for sustainable development in the age of information. Multilingual Matters.
- Scott, D. (2004). Conscripts of modernity. Duke University Press.
- Scott, D. (2004). Modernity that predated the modern: Sidney Mintz’s Caribbean. History Workshop Journal, 58. 191-210.
- Stellar, D. (2010, July). The PlayPump, what went wrong? Columbia University. https://blogs.ei.columbia.edu/2010/07/01/the-playpump-what-went-wrong/
- United Nations. (2018). Sustainable development goals. UN. https://sustainabledevelopment.un.org/?menu=1300
- Wachter-Boettcher, S. (2019). Technically Wrong: sexist apps, biased algorithms, and other threats of toxic tech. W.W. Norton Company.
- Wylie, I. (2012, December). Jugaad innovation: how to disrupt yourself. Think with Google. https://www.thinkwithgoogle.com/marketing-resources/jugaad-innovation/