Tuesday, December 8, 2009

Private Sector Leverages Comparative Advantage to Fight Slavery

As former lead diplomat and interagency coordinator in the federal government to fight human trafficking, I had the privilege to learn a ton about an often ignored, discounted, or misunderstood crime and abuse. From a woman I met in Romania who got TB as a sex trafficking victim in the UK, to the young woman I met in Bangkok who was subject to beating in a secluded Thai seafood processing factory after fleeing repressive Burma, human trafficking is about gross exploitation.

Sometimes it’s about moving across borders, but often it is not. Never having crossed any borders, the U.S.-citizen teenagers who are prostituted throughout America and the people of disadvantaged castes trapped in bonded labor in rice mills and brick kilns in India are human trafficking victims by dint of domestic law and U.N. protocols. “Trafficking” refers to the human trade – treating people as pure commodities robbed of freedom and equal dignity.

Eschewing jargon, human trafficking is best seen as slavery -- typically without chains, but slavery nonetheless.

While the public sector has much to do to help victims and punish their traffickers, so much is to be done by other actors.

I’m now the Executive Director and CEO of Polaris Project, named after the North Star which, with the help of ordinary citizens, guided slaves to freedom in the Underground Railroad. Polaris Project is devoted to breaking the backbone of traffickers in America by reducing the profit and raising the risk. The U.S. government has turned to us as a nimble NGO capable of running the primary national human trafficking hotline (1-888-3737-888) (http://nhtrc.polarisproject.org/ ) We serve as a catalyst in the anti-trafficking movement, from the essential micro level of victim services to the macro level of reforming laws and their implementation.

Not just nonprofits, but funders and investors outside of government are essential to the ultimate goal in fighting slavery today: abolition rather than mere mitigation and regulation.

Some philanthropic funders have entered this space. Humanity United funds anti-trafficking nonprofits and the leading coalition Alliance to End Slavery and Trafficking (aptly named ATEST, summoning the image of faithful witness to crimes against human dignity). Additionally, the NoVo Foundation, led by Jennifer and Peter Buffett, has committed to supporting work to empower women and girls against the dehumanization of sex trafficking. (Full disclosure: both fund Polaris Project.) Within a two-week period this autumn, Polaris Project was featured at the Clinton Global Initiative Annual Meeting where President Clinton highlighted human trafficking as a problem deserving action. Polaris Project was recognized for its anti-trafficking work in the U.S. and Japan and for the commitment it made to be an exemplar for the world. I also had the opportunity to speak at the annual meeting during the more politically conservative Philanthropy Roundtable. Yet there’s still a largely untapped opportunity for philanthropy to help the goal of abolition.

Businesses have a part to play too. First, they need to implement in deeds a kind of Hippocratic Oath to do no harm. They mustn’t wittingly or unwittingly spur on human trafficking. In the area of labor, businesses should make supply chains more accountable. The Department of Labor has given them a tool by promulgating a report on countries in which various sectors are tainted by forced labor and onerous child labor. Moreover, there need to be more businesses like Manpower Inc. who admirably seeks to eliminate shark-like labor recruiters who help enslave people through lies, seized passports, and usurious debt.

Businesses should also avert enabling human trafficking for sex—whether airlines and hotels work to not facilitate sex tourism; landlords rebuff brothels; or internet advertisers refuse to allow commercial sex (and with it, sex trafficking) to be promoted by their businesses.

Businesses can contribute to philanthropy against trafficking, and often have comparative advantages to bring to the fight. Just take three partners of Polaris Project:

The direct financial support, legal and technical advice, and research services of LexisNexis – is part of the company’s significant commitment to advancing the Rule of Law around the world. LexisNexis Risk & Information Analytics Group worked with Polaris Project to develop and implement a new web-based system that allows all employees of our national human trafficking hotline to access the same information in real time. It allows employees to service those in need by being able to field and respond to hotline calls more quickly and provide up-to-date, accurate information about local resources and service providers.

In late 2008, Wyndham Hotel Group generously donated one million Rewards points to Polaris Project. We utilize these points to provide emergency hotel stays to victims of human trafficking. Wyndham Hotel Group provides the first step in the recovery process for these victims who have nowhere else to turn. The support of Wyndham Hotel Group is so vital to victims of human trafficking that the Wyndham Hotel Group and Polaris Project relationship was listed in the 2009 Trafficking in Person (TIP) report released by the Secretary of State, Hillary Rodham Clinton last June.

And the aforementioned Manpower recently signed a partnership MOU with Polaris Project. Polaris Project will help Manpower employees gain more expertise on human trafficking in the labor market, and in turn Manpower will help Polaris Project by offering job training and job placement for victims we serve in places like Washington, DC; Newark, NJ; and Tokyo, Japan.
Philanthropists and businesses have slowly entered the fight to end human trafficking. But only when their role matches that in fields like development, international education, HIV/AIDS, and domestic violence will we have the hope of realizing the goal of a world without slavery.

By Ambassador Mark P. Lagon
Mark P. Lagon, PhD. is Executive Director and CEO of Polaris Project, a leading anti-human trafficking nonprofit, running the 1-888-3737-888 national hotline. He was formerly Ambassador-at-Large to Combat Trafficking in Persons at the Department of State.

Thursday, December 3, 2009

Leave the "overhead" to Santa

You're a savvy spender. You use the internet to compare prices, and in a tight economy, you're likely to spend a little time finding and settling on the best price to maximize your budget. Given your smart spending habits, you probably are thinking that the charity most deserving of your money this season is the one that spends the least amount on administrative costs. Before you visit Charity Navigator to see which group can divine the lowest overhead ratio, STOP! Let's think about this a minute.

If you had a choice this Christmas of giving to an organization that frees 10 girls from sex slavery in India and spends 10% on overhead costs or a group that rescues and rehabilitates 100 girls from the same desperate situation but spends 20% on overhead, I bet you'd choose the one that has the greater impact but spends a little more on overhead.

Overhead ratios are popular proxies for measuring efficiency. Especially when the charities you're interested in supporting are in developing countries. It's one thing to be able to see the impact of the local YMCA in the community but a whole other issue when you want to give to an organization in Zimbabwe that you can't see, where you know the government is corrupt, and with whom you may not have any personal relationships but where you know the need is great. It's not that these overhead ratios are a bad idea--it makes sense that you would want to contribute to an organization that spends more on children in need than on mailing out fund-raising letters. But efficiency measures miss the point and are often incorrectly calculated. What we really want is to give to organizations that are effective in changing people's lives for good. The trouble with this aspiration is that it's hard to figure out who is really effective at rehabilitating trafficked girls, healing sick people, eliminating homelessness or eradicating poverty.

When you think about giving to charity, it's my guess that you first give to causes you care about, to organizations you believe in or to programs that your friends ask you to support. If you have any largesse left after reading heart-tugging stories that pull at your wallet, it's possible that you might be looking for some way to compare various charities and decide which ones you will support.

This giving season, leave the "overhead" to Santa as he navigates his way down your chimney, and look for organizations who report on results, find user-reviews of non-profits at greatnonprofits.org, globalgiving.com, myphilanthropedia.org or givewell.net, and support organizations who work to measure, as best they can, the tangible ways that people's lives or the systems that impact them are changed.

Heidi Metcalf
Senior Fellow & Deputy Director
Center for Global Prosperity

Tuesday, December 1, 2009

The true cost of the public health approach to HIV/AIDS

This year’s World AIDS Day is particularly timely, arriving a day after World Health Organization recommends a “phase out” of one of its main ARV drugs: Stavudine.

The WHO promotes the public health approach to global AIDS: treat as many as possible, as quickly as possible, as cheaply as possible. In fact, all UN agencies and many NGOs followed WHO's lead and promoted a public health approach as well. In the public health approach, the interventions are designed to be quick, inexpensive, and cover as many people as possible--as in epidemics for infectious and parasitic diseases. On the other hand, in a clinical approach, medical records are the standard method for recording a patient's response to a therapy.

Now, some 4 million patients are under Antiretroviral (ARV) treatment, yet neither WHO nor any other UN agency has any patients' outcome data of a clinical nature to show for the billions expended--until yesterday. On November 30, the
WHO's press release recommended that "countries phase out the use of Stavudine, or 4dt, because of its long term, irreversible side-effects." Stavudine is one of the components of the triple dose combination ARV from India identified as the "backbone" of WHO's '3 by 5' program, launched in December 2003. Stavudine, in single or combination forms, is also one of the most widely used ARVs in Africa.

The triple dose combination ARV was licensed by the Drugs Controller General (India) as a 'formulation' on 26 July, 2001, with several conditions for its use. Among them:
1. "Warning": To be sold by retail as the prescription of a Registered Medical Practitioner only";
2. No reference in the advertisement or medical literature is made that the government has approved the drug.
WHO subordinated both conditions: the first by recommending that tens of thousands of community health workers (not registered medical practitioners) be trained to deliver ARVs and the second by lending its considerable institutional legitimacy to ARV formulations from India which hadn't been approved by any stringent regulatory authority.

Yesterday, the WHO recommended a phase out of this drug due to its long term, irreversible side-effects. If a clinical approach had been used in AIDS treatment, then we would know that patients were having adverse reactions to Stavudine because the medical records would reveal the progress of treatment or lack thereof. Clinicians would then change the therapy and monitor patients to see how they were responding.

To make matters worse, while the WHO has recommended the phase-out of Stavudine, it has not suggested a drug re-call, a standard practice of R&D companies in Japan, the EU, Australia, and the US. With a considerable pipe-line of Stavudine in process, how many more patients must suffer "irreversible side effects" in the absence of a drug re-call?

What is the cost for medical treatment of those affected with "irreversible side-effects" from its use? Did WHO recommend, according to the UN's Universal Declaration on Human Rights, that 'patient consent forms' be secured before Stavudine was administered? Given Stavudine's extensive use in Africa, it is likely that the long term medical care costs for these patients will be larger than the ARV treatment costs for the remainder of patients that were fortunate enough not to have followed WHO's original recommendation of December 2003.

How will AIDS treatment be sustained in the face of such irresponsible treatment protocols?

Stavudine should be the wake-up call for all agencies involved in the treatment of global AIDS. The best thing that the Global Fund can do to improve treatment of AIDS patients is to abandon the public health approach and adopt a clinical health approach. In the short-run, it may be more expensive, but as Stavudine has shown, in the long run it will be greatly less expensive.

Jeremiah Norris
Senior Fellow
Hudson Institute
Center for Science in Public Policy