Austerity across Africa has been operationalized through World Bank and IMF structural adjustment programs since the 1980s, later rebranded euphemistically as poverty reduction strategies in the late 1990s. Austerity's constraints on public spending led donors to a “civil society” focus in which NGOs would fill gaps in basic social services created by public sector contraction. One consequence was large-scale redirection of growing foreign aid flows away from public services to international NGOs. Austerity in Africa coincides with the emergence of what some anthropologists call “audit cultures” among donors. Extraordinary data collection infrastructures are demanded from recipient organizations in the name of transparency. However, the Mozambique experience described here reveals that these intensive audit cultures serve to obscure the destructive effects of NGO proliferation on public health systems.
James Pfeiffer is Professor in the Department of Global Health at the University of Washington with a joint appointment in the Department of Anthropology. He is Executive Director of Health Alliance International (HAI), a nonprofit based in Seattle and a program Center in the Department of Global Health. He oversees HAI's public sector health system strengthening projects in Mozambique, Côte d'Ivoire, and Timor Leste. He earned his PhD in anthropology and his MPH at the University of California, Los Angeles, and has worked extensively on primary health care, HIV/AIDS, reproductive health, and community health programs. Email: jamespf@uw.edu