如何破解富裕國家對外援助困境

Rich countries sent $137bn in aid to poor countries in 2014, plus large amounts given through non-governmental organisations. People give because they feel a moral obligation to help those who live and die in destitutione destitute. Yet we still do not know whether these gifts are helping or hurting, or how to use the money to good effect.

2014年，富裕國家向貧窮國家提供了1370億美元的援助，另外還有通過非政府組織(NGO)提供的大量資金。人們願意捐助，因爲他們覺得有道德義務去幫助那些赤貧之人。然而，我們仍不知道這些捐助對他們是幫助還是傷害，也不知道如何讓這些資金髮揮好的作用。

The obvious answer is to give to those who suffer most. Yet many of the people in the greatest need are those living live in countries where aid would be wasted — because of war, because their governments exploit their citizens rather than help them or because the state has little capacity to govern. Giving money directly to citizens, or via NGOs, does little to block a powerful “extractive” state.

看上去很明顯的答案是向那些處境最艱難的人提供援助。然而，許多最需要幫助的人都生活在援助被浪費的國家——因爲戰爭，因爲他們的政府剝削本國公民而非幫助他們，或是因爲政府幾乎沒有治理能力。把錢直接（或通過NGO）交給公民，無法阻止一個強大的“壓榨型”政府。

Aid given to good governments in poor countries can work, but capable governments have other, often better, alternatives, such as borrowing from international capital markets. Whatever the disposition of the government, large aid flows detach leaders from the needs of their people, making them like the autocrats who sit on mining and oil revenuesells whose revenues require no cooperation from their citizens. In Africa alone, there are more than a dozen governments who obtain more than half their revenue from foreign aid.

把援助交給貧窮國家的好政府可以發揮作用，但有能力的政府有其他（通常更好）的選擇，如從國際資本市場獲得貸款。無論什麼性質的政府，大量援助流入都會讓領導人脫離人民的需求，讓他們變得像坐擁礦山或石油收入而無需公民合作的獨裁者。僅在非洲，就有十多國政府超過一半的收入來自外國援助。

Aid administrators are impaled on this fork. Their home citizens want an impossible combination: aid, they say, must go to those in most need and aid must be effective.

援助管理者也很爲難。援助國公民的願望是一個不可能實現的組合：他們既要求援助必須發放給那些最需要的人，又希望援助必須產生預期效果。

What if we fund only those projects that have been thoroughly evaluated and shown to work? But evaluations rarely capture unintended consequences, such as the government reducing its provision when foreigners do its job for it, or when accountability to beneficiaries is lost by replacing internal by with external provision. The “what works” agenda also runs of the risk of replacing what (local) people want by what (often foreign) technocrats think they ought to have. It is these unintended consequences that explain why many projects succeed while the country fails.

如果我們只資助那些經過徹底評估並顯示可行的項目，結果會怎樣？但評估很少能預計到意想不到的後果，例如，當外國人幫一國政府履行了它該履行的職責，或者外國人提供的物資代替了一國內部提供的物資、使得該國政府喪失對受益者的責任感，該政府就會減少自身提供的物資。這種基於“可行項目”的援助理念還存在一種風險——以（通常是外國人的）技術專家認爲（當地）人民應該需要什麼代替後者真正需要什麼。正是這些意想不到的後果可以解釋，爲什麼許多項目成功了，而受援國卻垮掉了。

One solution to the aid dilemma is to work outside the recipient’s borders and provide global public goods. Examples include basic scientific research, particularly in health; better control of the arms trade (why are some European countries who are so enthusiastic about aid so keen to sell arms?); trade policies that help reduce poverty; and the provision of high-quality, unbiased advice to countries negotiating trade deals with richer, larger and better-prepared neighbours.

破解援助困境的方法之一是在受援國以外做工作，並提供全球公共產品。這樣的例子包括基礎科學研究，特別是在醫療領域；更好地控制武器貿易（爲什麼一些如此熱心對外援助的歐洲國家又如此熱衷於出售武器？）；實施有助於減少貧困的貿易政策；爲那些與更富有、更大、更有優勢的鄰國談判貿易協議的國家提供高質量、無偏見的建議。

For the same reasons, I am sympathetic to using aid funds to help refugees and migrants, not because they are poorer than those who are not moving — this is rarely the case — but because the money is spent in the donor country where outcomes can be monitored by the funders and are thus subject to informed democratic debate. Of course, we need to be careful which programmes are reduced when funds are reallocated.

出於同樣的原因，我贊成用援助資金幫助難民和移民，不是因爲他們比那些留在本國的人更貧窮（很少出現這種情況），而是因爲這樣一來錢就花在援助國國內，其效果可以由出資者監督，進而可以在信息充分的條件下進行民主辯論。當然，重新分配資金時，我們需要謹慎對待削減哪些項目。

Does this mean that help should only be provided from a distance? Does effective aid mean excluding those whose lives we know could be saved? I have to come to think not.

這是否意味着援助只應遠距離提供？有效的援助是否意味着要排除那些我們知道可以拯救、但是身處受援國國內的人？我不這樣認爲。

One of the greatest recent achievements of aid has been that so many are alive today who would be dead but for aid-funded antiretroviral therapies, as well as the many children whose lives have been saved by the use of insecticide-treated bed nets, and by reducing mother-to-child transmission of HIV. Even when aid-funded provision reduces local responsibility, risking future health, the issue becomes a trade-off between lives (certainly) saved today and lives (possibly) lost tomorrow. We should surely decide in favour of lives today, especially if we are careful to do what we can to minimise —I don’t believe we can eliminate—long-term negative consequences.

近年來最偉大的援助成就之一是，如果沒有援助的抗逆轉錄病毒療法，很多人可能活不到現在，還有許多兒童因使用經殺蟲劑處理的蚊帳以及母嬰間HIV病毒傳播的減少保住生命。即使援助提供的物品減少了當地政府的責任感，從而可能威脅該國民衆的未來健康，但這一問題是在今天（一定能夠）拯救的生命與明天（可能）失去的生命之間的取捨。我們當然應該做出保護今天的生命的決定，特別是如果我們小心翼翼地盡我們所能減少（我不相信我們能根除）長期的負面後果。

My belief that we should follow this route has been strengthened in recent conversations with the Global Fund to Fight Aids, Tuberculosis and Malaria. In most countries, the Global Fund is able to exploit the synergy that comes from the fact that their drugs are supplied in clinics that double up for other purposes, such as maternal and child health, thus improving overall health outcomes beyond those immediately targeted.

最近與全球艾滋病、肺結核和瘧疾基金(Global Fund to Fight Aids, Tuberculosis and Malaria)的交談加強了我對於我們應遵循此路線的信念。該基金之所以能夠在多數國家實現協同效應，是因爲他們的藥品是在那些同時提供其他醫療服務（如婦幼保健）的診所供應，從而可以在實現既定目標之外提升整體醫療效果。

The Global Fund agrees that it would be better if countries were to fund their own drugs and health systems, and the organisation has had considerable success in working towards country funding and away from international aid. This is an continuing process and it will take time for the Global Fund to close shop, which is its aim. But stopping today would cost many lives, too high a price to accept. Such life-saving programmes should therefore be excepted from the “not within the country” critique of aid.

該基金認爲，如果各國能爲本國的藥品及醫療系統提供資金的話將會更好，而該組織在幫助各國自己提供資金、而非依靠國際援助方面已經取得了相當大的成功。這是一個持續的過程，該基金要“關門大吉”還需要時日，而這正是它的目標。但如果今天就關門，許多生命將得不到挽救，這是一個高到無法讓人接受的代價。因此，此類挽救生命的項目不適用“不宜在受援國國內進行援助”的觀點。