Per Diem-Itis

In Tanzania, people are paid--sometimes quite well--to attend conferences or training events. This is a common practice; Western organizations have been paying "sitting fees" or "per diems" in developing countries for at least a few decades. The basic reasoning was something like this:  Salaries in developing countries are low, often barely enough to live on. Western organizations could help "top up" low salaries by giving per diems while at the same time guaranteeing good attendance at their events. 

As development aid increased, more and more conferences were offered and the practice of giving per diems hardened. People came to feel entitled to them, and not surprisingly, corruption and abuse of the system spread. There are accounts of people attending workshops in languages they don't understand, people signing in for absent colleagues, or attending the same conference multiple times in order to collect the fees. 

During two recent training events participants hit the roof when Duncan and his team announced that they would not pay per diems.  Teaching came to a complete stop as participants loudly threatened to leave.  "We need some incentive to learn! We cannot learn if there is no motivation!"     

The team explained that the terms of their funding prohibit them from giving per diems. More heated discussion followed; their schedule was completely thrown off. The team eventually gave participants the option to leave. When people saw they would not budge, they all ended up staying. 

Our initial reaction to this was disgust. After all, where we come from, don't people pay to attend conferences?  Isn't learning seen as a valuable thing on its own? It seemed outrageous that health care professionals would demand cash in order to "be motivated to learn" how to better care for patients. 

But we have to acknowledge that Western NGOs helped to create this expectation in the first place. Now Western NGOs have to decide whether giving per diems actually does more harm than good. We also have to acknowledge that where we come from, salaries are much higher, the conferences we attend are often paid for by our employers, and learning more generally pays off in terms of expanded career opportunity. So it's not entirely fair of us to get worked up into a self-righteous huff about per diems without thinking about the underlying factors. I guess it shows us again just how easy it is for an outside party with good intentions to introduce ideas and practices that mutate into something very unexpected and very hard to undo.