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  • Print publication year: 2017
  • Online publication date: November 2017

3 - Principal–Agent Problems and AIDS Interventions in Africa


But if things go through so many places, justice cannot be done since people want those things as well. From one place to another, many people would want to benefit something. As such, things can't reach far.

Headman Interview #82, Mchinji District, July 11, 2008

Government is soliciting funds from donors for HIV/AIDS cases but in turn the moneys end up being swindled by unscrupulous individuals who have no welfare of people at heart.

Malawian Journals Project, Distonie Daison, April 14, 2005

Imagine two HIV testing counselors, paid the same wage by the Ministry of Health. One works in an area mistrustful of government health initiatives, especially those involving blood tests, and so she puts forth a great deal of effort to mobilize people to get tested; she rides her bike to far-flung villages and holds village meetings promoting HIV testing. Her colleague, however, works in an area where people are more trusting of government health initiatives and where there is already high awareness about and acceptance of HIV testing. This second HIV testing counselor can stay in his office and play games on his mobile phone or read the newspaper while waiting for clients to come by his office to be HIV tested. The end-of-quarter report by the Ministry of Health enumerating the number of people HIV tested could show similar output by these two HIV testing counselors, even though their levels of effort were markedly different. The quantitative nature of reporting gives no indication of the quality of the work nor of accountability to intended beneficiaries (Ebrahim, 2003, 816). Because these HIV testing counselors were paid the same wages, financial incentives cannot explain their different levels of effort. I witnessed many situations like these in Malawi – where people in similar positions differed in how hard they worked for AIDS interventions. The difference I saw in what motivated these agents was their personal experience with AIDS and their consequent preferences that AIDS be prioritized.