Measuring Impact


Measuring Impact

Yesterday I heard a BBC discussion with Microsoft's Bill Gates on development aid and his program to immunize millions of children against a range of preventable diseases. According to the statistics used, 9 million children die annually from such diseases. The goal of the vaccination program is to bring this number down to 3 million. He is donating $20 billion to fund this program - $3,333 per life saved. The focus, however, is on “lives lost to preventable diseases”, not “lives lost”.

When I started working in the sea villages of South Java nearly 40 years ago, I used to ask people how many children they had. They would give two numbers, the number born and the number still alive. In the case of my foreman, ten were born, but only two were still alive. The percentage was better for other workers, but the mortality rate was still alarmingly high.

Malnutrition and severe food shortages were part of life in these villages. If more children had lived, the shortages would have been even more severe and children would have died in greater numbers from malnutrition. The overall impact of an immunization program to reduce the death rate from preventable diseases would have been to increase the death-rate from food shortages.

Piecemeal solutions, no matter how attractive and well-intentioned, are rarely an answer to complex problems in developing countries.

Indeed immunization may even lessen the body’s ability to fight other diseases. Measles was common in Ireland when I was a child. When one child caught it, the rest were put in the same room and all got it together. Then they were immune.

Children have to be fed, housed, clothed, educated, given employment etc. Programs that target one problem only and ignore the context in which the child lives are unlikely to succeed and may fritter away much needed resources for sustainable development. Much of the money from the Gates Foundation will go to large pharmaceutical companies and for research and distribution.

$3,333 would pay a labourer’s wages for 3 years and enable him to support his family. His work would be an asset for long-term, sustainable development.

Charlie Burrows OMI

Cilacap, Indonesia


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