who's in charge here?

Working in the field of public health and international development can be challenging. There are no easy solutions; nothing comes without consequences down-stream. There are cultures to consider, limited resources to allocate, expectations to manage, and motivations to deconstruct. On the surface, Uganda is flooded with NGOs working towards development to such an extent that it can be argued that a middle class has been built on the business of development here. In my short ten minute walk to work, I pass offices for 5 different NGOs all working on different aspects of development (HIV advocacy, land and property rights, agriculture x2, and ICT access). Within Kampala I have friends working for disability rights, environmental conservation, community health in slums, sex worker rights, ARV access, poverty, malaria prevention, entrepreneurship, and the list goes on.

One-third of Uganda's budget is foreign aid, and the non-governmental sector is simultaneously inundated with foreign money (and foreign priorities, ideas, and goals) and deprived of adequate resources to successfully implement programs and have a measurable impact. In my experience, sincere efforts at community-based, participatory methods are extremely limited.  Development is donor driven. 

Despite vast (and possibly even sincere) efforts towards development, Uganda is a country with the highest malaria incidence in the world, where mothers give birth to an average of 7 babies in a lifetime, where 8% of adults have HIV, where more than half the population is living below the international poverty line, and where most demographic indicators have stagnated since the 1970s. All this despite effort, despite money, and despite the NGO renaissance taking place in Kampala.

But in the business of development, failure is not an option. However, reassessing our strategies should be. Although I have only been in Uganda for 5 months, the question I came here with still plagues me: Who is setting the development agenda and for who's benefit?  Everyday I get hints towards an answer that I am a little afraid of facing.