questions in the design of the program. I don’t think you can talk about ethical criteria unless you have some idea of what the program is. I have to confess, after two days, I really don’t know what the program is meant to be. I have a feeling that I know where the committee is going. I have a feeling that [the funding organizations] had something else in mind. So what results, we will see.

I was thinking, what are the models? One model is the groups that do the emergency humanitarian intervention. There is an earthquake, and 75 aid groups all show up. They start pointing fingers at each other saying “We’re the only sincere people here. You don’t know what you are doing. You are just trying to increase your donations.” They start fighting over who gets credit for what. Nothing is coordinated. There are major lapses. No one is keeping score. There is no one in charge, so there is no overall plan to make sure that all the bases are covered.

So what have you got? You have some really wonderful agencies that do wonderful work and try to keep tabs on each other as best they can. Their work is complicated by all kinds of other players who run around doing their own thing, sometimes tripping up the activities of the best agencies.

So that is not so great. It is not the model for this, obviously, partly because it is a very flawed model, and the better agencies all know it and they are trying to do something about it. But also these are very short-term interventions. As soon as you get things fixed up and stabilized, you are off to the next emergency. They happen because, usually, there has been a total breakdown.

The model for PEPFAR, of course, is totally different. You are basically thinking about stable regimes, with tragically stable or long-term patterns of suffering, and, presumably, one is there for the long haul. So that is not the right model.

What is the better model? Number two is what is already happening. We have heard for two days that there are a lot of people over there, a lot of Americans over there, working for different agencies, doing good work—God’s work, as one might say. And bless them.

But this is sort of a bouquet of individual initiatives. Again, there is no one keeping score. There is no one in charge, no one who is trying to say, “Yes, we have covered all the main bases here,” or, “I know you came over and you want to do this, but the real need is over here. Would you please do that?” There is nobody to report to and nobody to check off the needs and so on. So that is what is there.

Now, it is possible that what the [funders of PEPFAR] have in mind is that they would be something like that. Actually, what I heard was something less than that. They just want to encourage lots more of the shoots to come up.



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