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Spend the money

President Barack Obama is asking Congress for $6 billion in emergency funds to fight Ebola, including $2 billion for the U.S. Agency for International Development to spend on health care in West Africa. But an analysis of federal spending shows that in the five years leading up to the Ebola outbreak, his administration struggled to spend the money Congress had already made available.

From 2009 through 2013, Congress appropriated $243 million for health-related spending in Liberia, the bulk of it through USAID, according to ForeignAssistance.gov.

Guinea and Sierra Leone, the other countries affected by the outbreak, got a fraction of that amount. Yet the U.S. government managed to spend just $152 million over that same period, or 63 percent.

When asked for comment on that spending, the agency said it was more reasonable to look only at a more restrictive category of money--what's called the Global Health Program. Using that criteria, the U.S. government spent $99 million on health aid to Liberia over the same period, out of $135 million Congress appropriated. That's a spend rate of 73 percent.

In the five years leading up to the Ebola outbreak, the U.S. was able to spend more than 83 percent of the $67 million Congress made available for fighting malaria, and 87 percent of the $19 million appropriated for HIV/AIDS. By contrast, it spent just 63 percent of the $39 million appropriated for maternal and child health, and 56 percent of the $32 million appropriated for family planning and reproductive health.

What explains USAID leaving so much of its health-care budget for Liberia unspent? One possible explanation is that health care in Liberia wasn't the priority that, in hindsight, it should have been.

It may have seemed reasonable for USAID to focus on other priorities. Ben Leo, former global policy director for Bono's ONE campaign and now a senior fellow at the Washington-based Center for Global Development, told me that after Liberia emerged from civil war in 2003, it made sense for foreign aid to focus on security and basic infrastructure.

A more charitable explanation is that spending development money responsibly in West Africa is just really, really hard.

It's possible that USAID, which typically uses third-party organizations to deliver aid programs, didn't spend more of this money because it couldn't find enough nongovernmental organizations, aid groups or government agencies to give it to.

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Christopher Flavelle writes editorials on health care, economics and taxation for Bloomberg News.

Editorial on 11/08/2014

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