March 4, 2009

The showcase missions

Juan Cristobal says: - There's not a lot of room for consensus in today's hyper-polarized Venezuela. One of the few, though, is the idea that the Revolution has brought the debate about poverty and exclusion up front and center.

For years, social policy was an afterthought. The continuing slide in social statistics that began in the late '70s was like the pink elephant in the middle of the sarao that nobody wanted to talk about.

That's all changed. Whether we like it or not, getting people out of poverty and empowering them is the central debate in the coming years.

If the opposition is to take power, we will need to have a social message. And any social message, any policy proposal, begins with an assessment of the government's record. We need to ask ourselves what has worked, what hasn't and how we can make it better. And we need answer these questions in voters' minds.

Keeping track of the government's social programs, the Misiones, can be a tough task. Seems like every Simón, Antonio José or José Felix that populates the lore of revolutionary legend gets his or her own Misión. In fact, Misiones are usually named before they have been designed or have actually accomplished anything (Misión Villanueva, anyone?), so it's no surprise that many of them fail to get off the ground.

The other complication is that social policy is not just about what it achieves but how it achieves it. After all, you could design a program to, say, eradicate illiteracy and think it a success, even if it cost hundreds of millions of dollars, even though the same outcome could have been achieved for less, or even though that money could be put to better use by, say, eradicating TB. This kind of thinking is banished from VTV: optimizing the use of scarce resources between different alternative uses being as appealing a concept to chavistas as garlic chokers to the kids from Twilight.

One way to parse this patchwork of policies is to divide them between those that really count, and those that do not. In other words, the Misiones that actually matter and the other ones. In this post, I deal with the first group, the three Misiones that actually matter: Misión Barrio Adentro, Misión Mercal and Misión Robinson.

Barrio Adentro: a Cuban in every octagon, a pill in every mouth
Misión Barrio Adentro was created in 2003 to provide free primary health care to millions of poor Venezuelans. The program consists of a network of outpatient clinics, or modules, placed in the middle of poor neighborhoods, usually staffed by one or more Cuban doctors and Venezuelan nursing staff. For some strange, perhaps holistic reason, the modules are octagonal.

There are no reliable statistics on the actual number of modules opened, the number of Cuban doctors that are working in the country or the number of cases that have been seen. The government's statistics are hard to find, and even harder to believe. For instance, the statistics page in the Misión's website indicates that the Misión staff in the state of Miranda saw 3.1 million cases in January of 2004 alone!

The fact that January of 2004 is the last month to be listed in the web page speaks volumes about the government's whole attitude to evidence based policy. Like much of Misión-world, Barrio Adentro is an accountability-free zone, as though asking questions such as "but are we really getting our money's worth out of these modules?" or "is there a way to obtain better health outcomes out of the same level of spending?" were somehow unpatriotic.

The program's popularity is undeniable, and it ranks high on the list of achievements public opinion credits the government with. Undoubtedly, this is a reflection of the simple fact that people who had probably seldom seen a doctor before now have one right around the corner.

How many of them? Who knows. At what cost? Your guess is as good as than mine.

One of the few independent articles that try to assess the Misiones was published by Venezuelan think-tank ILDIS. The study, co-authored by Yolanda D'Elia, says that by 2006 there were 8,573 modules staffed by 14,000 Cuban doctors and 1,100 Venezuelan doctors. But, again, most of the statistics quoted by the authors come from the government, and are not independently audited.

So are the figures true? Have there really been hundreds of millions of cases? Are there more than 8,000 modules operating?

Nobody knows.

It's also impossible to ignore the frequent reports of problems. Abandoned modules are routinely reported, some Cuban doctors have defected, and the program has been criticized for not being able to care for common emergencies such as gunshot wounds. In spite of this enormous investment, there has been little progress in solving preventable health problems such as TB or maternal mortality. Some Cuban doctors live in precarious conditions, as guests in the homes of neighbors and for little pay. By some accounts, the Cuban government's effective rate of tax on their income is well over 90%. There have been reports of medical malpractice and of administering "pills" in inappropriate ways. Even chavista website Aporrea has joined in the criticisms. It's no wonder that people such as Francisco Rodríguez are calling the government's bluff and framing the achievements of the government's social programs as more "bulla" than "cabuya".

It's important for an assessment of Barrio Adentro to be balanced. While it is true that it has successfully brought health care to a lot of communities that didn't have access to it, serious doubts remain about its scope, impact, cost and, hence, long-term viability.

At the very least, though, thoughtful chavistas have to accept that it would be a remarkable, freakish coincidence if the program's design just happened to be the most efficient and effective design possible, given the government's disinterest in measuring the program's efficiency and effectiveness, let alone trying to optimize it. So long as words like "efficiency" "optimization" and "monitoring" are treated as suspect categories shot through with imperialist ideology, it's easy to see that we'll get mostly inefficient social programs that are not optimized because they receive little monitoring.

Robinson: learning to read, learning to spin
No program typifies chavismo's penchant for hyperbole better than Misión Robinson, the government's literacy program. No government official ever talks about Robinson without repeating the ridiculous claim that Venezuela, in a matter of months, eliminated illiteracy.

But international statistics beg to differ. The UNDP was quick to list Venezuela's literacy rate as somewhere between that of Paraguay and the Phillipines, while Unesco lists Venezuela under "data missing." Not surprisingly, Unesco denies Chávez's claims.

So which one is it? Have there been gains in literacy, or has this been just a bunch of lies by the government? Turns out, a little bit of both.

Francisco Rodríguez again, this time with Daniel Ortega, took a closer look at literacy trends and the real effects of Misión Robinson. They find, at most, a "small positive effect" that is inconsistent with the government's claim. They also find most of the advances in literacy are the result of long term demographic trends - younger people get more schooling than their parents and grandparents, and as the older generation dies, literacy rates go up. They call Misión Robinson another "expensive failure."

So we have a program that costs nobody knows how much and clearly benefits fewer people than the government claims. And we're supposed to sit still while chavismo holds this up as a monumental achievement?

Actually, yes. For a politician, fixating on the statistical analysis and agreeing with Rodríguez and Ortega's conclusion is a dangerous proposition. Such a critical stance is easy to misrepresent as a dismissal of the real achievements the Robinson program for some recipients.

Few things are more empowering than learning to read and write as an adult. Undoubtedly, some Venezuelans have benefited from Robinson, and many more know someone in their family or their neighborhood who has. Denying this program's effect or getting lost in macro-statistics can run you the real risk of appearing out of touch, of dismissing a program that is responsible for transforming the lives of some of Venezuela's most vulnerable people. And that is hard to recover from.

And so politicians point out Misión Robinson's shortcomings at their own peril. Even valid criticisms are easy for chavistas to caricature, and in an era of growing chavista dominance of the airwaves, attacks are difficult for opposition politicos to rebut.

Be that as it may, the government's disinterest in accountability and evidence-based policy making raises troubling questions: had the program's effectiveness been carefully monitored and its efficiency optimized, how many more people could have been taught to read and write for the same level of public spending? In other words, how many Venezuelan adults today are illiterate due to waste and mismanagement in Misión Robinson? We have no way to answer these questions, because the government won't publish credible data.

Mercal: Cheap food for all, if you can find it
The final flagship is also an expensive one. Misión Mercal is a network of mostly government-owned and -operated grocery stores, where goods and staples are sold at very low prices. Through a variety of subsidies and by taking out the middle man and importing food directly, Mercal is allegedly able to offer consumers groceries 50% below competing prices.

It is, undoubtedly, one of the most popular of all missions, and it yields a delicious irony: a socialist government propping up its popularity by subsidizing the cheap consumption of imported food.

Because, after all, that is what Mercal is, a massive handout. This is not bad per se: a lot of poor people in Venezuela can't make do every quince y último, so on that basis alone Mercal could even be deemed worthy social policy.

And yet Mercal is probably the poster child for a good idea gone wrong. In order to assist the poor in their grocery shopping, you have to determine who the poor are and what their basic needs are. Mercal does none of this.

The problem is that anyone can buy from Mercal. In fact the government even boasts that Mercal is beginning to reach the middle class! Even chavista web sites claim the middle class loves Mercal because of its "high quality" and "low prices."

Other problems with Mercal have surfaced. During 2007, the general scarcity in the country hit Mercal particularly hard. Because of its complexity, the distribution chain can break down easily. Time and again, the shelves at Mercal will be empty, while street vendors carry Mercal staples at unregulated prices. This being the Venezuelan military, it was inevitable that corruption would rear its ugly head. Perhaps because of this, the government shifted the responsibility to PDVSA and created PDVAL, a parallel network that is also not immune from hanky-panky.

But as with the other Misiones, Mercal is a story of a glass half-full. In an abstract sense, it is social policy bordering on the insane - cheap food for anyone who wants it, with a bunch of bureaucrats in charge with no oversight. Haven't we seen this movie before? Will we be surprised if this white elephant crashes and burns?

But tell that to the doñita who finds what she wants and has money left over. Denying Mercal's real benefits, or pointing out that it's nothing new, makes you quasi-unelectable.

Disagreeing with policies that are clearly popular and have evidently benefited some people is quite a challenge for the opposition. Perhaps the difficulty in overcoming it is what prevents them from even approaching the subject - they fear opening their mouths and instantly coming across as wanting to do away with the Misiones instead of wanting to improve them.

But criticize they must, because these programs are far from perfect.