A US Navy corpsman gives first aid to an injured Iraqi citizen

First aid is the provision of initial care for an illness or injury. It is usually performed by non-expert, but trained personnel to a sick or injured person until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care past the first aid intervention. It generally consists of a series of simple and in some cases, potentially life-saving techniques that an individual can be trained to perform with minimal equipment.

While first aid can also be performed on all animals, the term generally refers to care of human patients.

History[link]

The instances of recorded first aid were provided by religious knights, such as the Knights Hospitaller, formed in the 11th century, providing care to pilgrims and knights, and training other knights in how to treat common battlefield injuries.^[1] The practice of first aid fell largely in to disuse during the High Middle Ages, and organized societies were not seen again until in 1859 Jean-Henri Dunant organized local villagers to help victims of the Battle of Solferino, including the provision of first aid. Four years later, four nations met in Geneva and formed the organization which has grown into the Red Cross, with a key stated aim of "aid to sick and wounded soldiers in the field".^[1] This was followed by the formation of St. John Ambulance in 1877, based on the principles of the Knights Hospitaller, to teach first aid, and numerous other organization joined them with the term first aid first coined in 1878 as civilian ambulance services spread as a combination of "first treatment" and "national aid"^[1] in large railway centres and mining districts as well as with police forces. In 1878 Surgeon-Major Peter Shepherd, together with Colonel Francis Duncan established the concept of teaching first aid skills to civilians. Shepherd, together with a Dr Coleman, conducted the first class in the hall of the Presbyterian school in Woolwich using a comprehensive first aid curriculum that he had developed. It was Shepherd who first used the English term "first aid for the injured"^[2]First aid training began to spread through the empire through organisations such as St. John, often starting, as in the UK, with high risk activities such as ports and railways.^[3]

Many developments in first aid and many other medical techniques have been driven by wars, such as in the case of the American Civil War, which prompted Clara Barton to organize the American Red Cross.^[4] Today, there are several groups that promote first aid, such as the military and the Scouting movement. New techniques and equipment have helped make today’s first aid simple and effective.

Aims[link]

The key aims of first aid can be summarized in three key points:^[5]

• Preserve life: the overriding aim of all medical care, including first aid, is to save lives
• Prevent further harm: also sometimes called prevent the condition from worsening, or danger of further injury, this covers both external factors, such as moving a patient away from any cause of harm, and applying first aid techniques to prevent worsening of the condition, such as applying pressure to stop a bleed becoming dangerous.
• Promote recovery: first aid also involves trying to start the recovery process from the illness or injury, and in some cases might involve completing a treatment, such as in the case of applying a plaster to a small wound

First aid training also involves the prevention of initial injury and responder safety, and the treatment phases.

Key skills[link]

This unreferenced section requires citations to ensure verifiability.

In case of tongue fallen backwards, blocking the airway, it is necessary to hyperextend the head and pull up the chin, so that the tongue lifts and clears the airway.

Certain skills are considered essential to the provision of first aid and are taught ubiquitously. Particularly the "ABC"s of first aid, which focus on critical life-saving intervention, must be rendered before treatment of less serious injuries. ABC stands for Airway, Breathing, and Circulation. The same mnemonic is used by all emergency health professionals. Attention must first be brought to the airway to ensure it is clear. Obstruction (choking) is a life-threatening emergency. Following evaluation of the airway, a first aid attendant would determine adequacy of breathing and provide rescue breathing if necessary. Assessment of circulation is now not usually carried out for patients who are not breathing, with first aiders now trained to go straight to chest compressions (and thus providing artificial circulation) but pulse checks may be done on less serious patients.

Some organizations add a fourth step of "D" for Deadly bleeding or Defibrillation, while others consider this as part of the Circulation step. Variations on techniques to evaluate and maintain the ABCs depend on the skill level of the first aider. Once the ABCs are secured, first aiders can begin additional treatments, as required. Some organizations teach the same order of priority using the "3Bs": Breathing, Bleeding, and Bones (or "4Bs": Breathing, Bleeding, Brain, and Bones). While the ABCs and 3Bs are taught to be performed sequentially, certain conditions may require the consideration of two steps simultaneously. This includes the provision of both artificial respiration and chest compressions to someone who is not breathing and has no pulse, and the consideration of cervical spine injuries when ensuring an open airway.

Preserving life[link]

In order to stay alive, all persons need to have an open airway—a clear passage where air can move in through the mouth or nose through the pharynx and down in to the lungs, without obstruction. Conscious people will maintain their own airway automatically, but those who are unconscious (with a GCS of less than 8) may be unable to maintain a patent airway, as the part of the brain which automatically controls breathing in normal situations may not be functioning.

If the patient was breathing, a first aider would normally then place them in the recovery position, with the patient leant over on their side, which also has the effect of clearing the tongue from the pharynx. It also avoids a common cause of death in unconscious patients, which is choking on regurgitated stomach contents.

The airway can also become blocked through a foreign object becoming lodged in the pharynx or larynx, commonly called choking. The first aider will be taught to deal with this through a combination of ‘back slaps’ and ‘abdominal thrusts’.

Once the airway has been opened, the first aider would assess to see if the patient is breathing. If there is no breathing, or the patient is not breathing normally, such as agonal breathing, the first aider would undertake what is probably the most recognized first aid procedure—cardiopulmonary resuscitation or CPR, which involves breathing for the patient, and manually massaging the heart to promote blood flow around the body.

Promoting recovery[link]

The first aider is also likely to be trained in dealing with injuries such as cuts, grazes or bone fracture. They may be able to deal with the situation in its entirety (a small adhesive bandage on a paper cut), or may be required to maintain the condition of something like a broken bone, until the next stage of definitive care (usually an ambulance) arrives.

Training[link]

First aid scenario training in progress

Basic principles, such as knowing to use an adhesive bandage or applying direct pressure on a bleed, are often acquired passively through life experiences. However, to provide effective, life-saving first aid interventions requires instruction and practical training. This is especially true where it relates to potentially fatal illnesses and injuries, such as those that require cardiopulmonary resuscitation (CPR); these procedures may be invasive, and carry a risk of further injury to the patient and the provider. As with any training, it is more useful if it occurs before an actual emergency, and in many countries, emergency ambulance dispatchers may give basic first aid instructions over the phone while the ambulance is on the way.

Training is generally provided by attending a course, typically leading to certification. Due to regular changes in procedures and protocols, based on updated clinical knowledge, and to maintain skill, attendance at regular refresher courses or re-certification is often necessary. First aid training is often available through community organizations such as the Red Cross and St. John Ambulance, or through commercial providers, who will train people for a fee. This commercial training is most common for training of employees to perform first aid in their workplace. Many community organizations also provide a commercial service, which complements their community programmes.

Australia[link]

In Australia, nationally-recognized first aid certificates may only be issued by registered training organisations that are accredited on the National Training Information System (NTIS). Courses are based on the delivery and assessment of units of competency from various training packages.^[6] Most first aid certificates are issued at one of three levels::

• Provide Basic Emergency Life Support. Formerly Level 1 (or “Basic First Aid”, or “Basic Life Support”) this is a 1-day course covering primarily life-threatening emergencies. It involves the training and assessment of HLTFA201A from the HLT07 Health Training Package^[7]
• Apply First Aid. Formerly Level 2 (“Senior First Aid”) is either a 2 day face to face course or 1 day face to face combined with 4 - 8 theory work at home or online. It involves the delivery and assessment of HLTFA301B Apply First Aid. It covers all the aspects of training in "Provide Basic Emergency Life Support, as well as specialized training for treatment of burns, bites, stings, electric shock and poisons and the use of an AED. Apply First Aid must be re-accredited every three years to remain current for use in the workplace^[8] Reaccreditation of the CPR component (HLTFACPR201)^[7] is generally required annually, although individual states set the specific requirements.
• Apply Advanced First Aid. Formerly Level 3 (“Occupational First Aid”) is a three or four day course covering advanced first aid, use of oxygen and automated external defibrillators and documentation. It is suitable for workplace first aiders and those who manage first aid facilities. It is based on the training and assessment of a group of units of competency - HLTFA301B Apply first aid, HLTFA402B Apply advanced first aid and HLTFA403A Manage first aid in the workplace - that are generally delivered together.

Other courses outside these levels are commonly taught, including CPR-only courses, Advanced Resuscitation, Remote Area or Wilderness First Aid, Administering Medications (such as salbutamol or the EpiPen) and specialized courses for parents, school teachers, community first responders or hazardous workplace first aiders. CPR Re-accreditation courses are sometimes required yearly, regardless of the length of the overall certification.

Canada[link]

In Canada, first aid certificates can be issued under the auspices one of four training organizations that authorize 'course providers' to provide their particular "brand" of first aid training in up to ten provinces and three territories (thus, nationally): Canadian Red Cross Society, (Royal)Lifesaving Society (Canada), St. John Ambulance, and Canadian Ski Patrol. Besides first aid courses for the general public, such as "Emergency" and "Standard" first aid, which incorporates and includes CPR, most of these organizations also administer more specialized training, for example "Aquatic Emergency Care" for life guards (Lifesaving Society), "Wilderness First Aid" (St. John Ambulance), first aid that meets regulations for employment as a child care worker (Cdn. Red Cross Society) and first aid training that meets regulations for first aid attendants employed in the workplace.

Workplaces can come under occupational health and safety and insurance regulations that are either provincial (e.g. construction work sites) or federal (e.g. air, rail or marine transportation). Therefore, these national first aid training organizations offer workplace first aid training that complies with the specific training requirements, standards and syllabi set either by a given province or else by the particular federal regulatory requirement (for example, maritime industry first aid for ships crew and officers, or commercial aviation first aid for air transport crew such as airline flight attendants and pilots.

First aid training leading to certification that meets provincial workplace standards can also be offered through private training companies that have to be accredited and authorized by the relevant provincial regulatory agency or ministry. For example, the British Columbia provincial Workers Compensation Board (Worksafe BC) sets out OFA Occupational First Aid training and certification standards and requirements at 3 levels ranging from 8 to more than 40 hours.

Beyond 'first aid' training and certification are standards for 'pre-hospital care' such as 'first responder', 'emergency medical responder', paramedic and other titles. For example, fire-rescue personnel and paramedical personnel provide care that goes beyond 'first aid'. Yet a police officer might only be required to hold a first aid, not a pre-hospital care first aid 'ticket' as part of his or her current qualification. The military train in first aid and pre-hospital emergency care that is oriented to combat and other military situations and environments.

The training syllabi (course content) for "Emergency" First Aid (around 8 hours; 8 hours when recertifying; basically CPR along with treatment for shock and a few other life threatening conditions such as anaphylaxis and severe bleeding) and "Standard" First Aid (around 16 hours, but 8 hours to recertify within a certain recurrency period - otherwise re-do the 16 hours) are set out by Health Canada, a federal department of the Government of Canada which accredits a training organization as a course provider of these two basic certificates, needed by those people employed in federally regulated workplaces.

Workplace safety regulations and standards for first aid vary by province depending on occupation. However, as some occupations are governed by federal, not provincial, workplace safety regulations, such as the transportation industry (marine, aviation, rail), trainees need to confirm with their employer as to exactly what specific training and certification standards comply with the applicable regulatory agencies, federal or provincial.

• Emergency First Aid: is an 8-hour course covering primarily life-threatening emergencies: CPR, bleeding, choking and other life-threatening medical emergencies.
• Standard First Aid: is a 16-hour course that covers the same material as Emergency First Aid and will include training for some, but not all, of the following: s; burns; poisons, bites and stings; eye injuries; head and neck injuries; chest injuries; wound care; emergency child birth; and multiple casualty management.

CPR certification in Canada is broken into several levels. Depending on the level, the lay person will learn the basic one-person CPR and choking procedures for adults, and perhaps children, and infants. Higher-level designations also require two-person CPR to be learned. Depending on provincial laws, trainees may also learn the basics of automated external defibrillation (AED).^[9]

• Level A is the lowest level of CPR training. Trainees learn how to perform the standard one-rescuer CPR and choking procedures on adults.
• Level B requires the same procedures as Level A, but trainees learn to perform these maneuvers on children and infants in addition to adults.
• Level C requires the same maneuvers as Level B, and trainees are also taught how to perform two-person CPR.
• Level HCP (Health Care Professional) was introduced in Canada in response to new guidelines set by the International Liaison Committee on Resuscitation.^[10] In addition to the techniques taught in Level C, artificial resuscitation, AED use (to certification standards), and bag-valve-mask use is taught. Anyone with CPR-HCP certification is considered AED certified.

France[link]

In France, first aid certificates are delivered by organisations that are approved by the Minister of the Interior, following the official national reference document (Référentiel national, RN). There are about 20 approved associations (Croix-rouge française, Fédération Nationale de Protection Civile, Fédération des secouristes français Croix-Blanche, Œuvres hospitalières françaises de l'ordre de Malte, Union nationale de protection civile, Association nationale des premiers secours, …); many administrations — army, fire services, national education, … — are also approved.

• at school: basics must be taught at the primary school
  • grande section de maternelle (5 years old): to detect a danger, to look for an adult,
  • cours élémentaire 1 (CE1, 7 years old): to protect oneself, to call for help,
  • cours moyen 2 (CM2, 10 years old): to make a complete phone call, to place a casualty in an adapted position (sitting, lying, recovery position);
• at the Journée défense et citoyenneté (Information to the army careers): IAPS, Initiation à l'alerte et aux premiers secours (initiation to call for help and first aid)
  1. Securing.
  2. Calling for help.
  3. The casualty is not alert (recovery position).
  4. The casualty is not breathing (CPR, AED).
• PSC1: Prévention et secours civiques de niveau 1 (Prevention and civic aid, level 1): 10 hours,
  1. Securing (including emergency casualty movement).
  2. Calling for help.
  3. The casualty is choking.
  4. The casualty bleeds deadly.
  5. The casualty is not alert (recovery position).
  6. The casualty is not breathing (CPR, AED, including children and babies).
  7. The casualty complains about illness (including strokes and heart infarction).
  8. The casualty complains after a trauma (burns, wounds, broken bones, joint sprains and dislocations).
• SST: Sauvetage-secourisme du travail (first aid at work): similar to PSC1, with a study of the specific risks of the activity of the worker;
• PSE: premiers secours en équipe (team first aid, certified first responders):
  • PSE1 (level 1): 35 hrs, acting as a member of a first aid organisation
    general principles (managing stress, relationships to the casualty and the bystanders, hygiene, being part of a team, security, basic anatomy), advanced assessment (check pupils, check pulse, pain assessment), cervical collar, suction, oxygen first aid, basic bandages and tourniquets, methods with two team members (emergency movements, recovery position, removal of a helmet, jaw thrust, CPR), specific cases (amputations, casualty in a car, drowning), simple patient transport (walking, sitting in a chair);
  • PSE2 (level 2): 35 hrs, acting as a member of a rescue team
    managing the medical wastes, cleaning an ambulance and the first aid material, reacting to an accidental contact with blood, complete assessment (including blood pressure cuff, pulse oximeter, ear thermometer), two-way radio, specific cases (bites, stings, intoxication, blast, rhabdomyolysis, heat stroke, hypothermia, hanging and strangulation, convulsions, diabetes, anaphylaxis, pregnancy, behaviour disorders), advanced bandages, preservation of an amputated limb, member realignment and splints (including cervical collar, KED, long spine board with side head supports, vacuum mattress, Donway traction splints), casualty lifting (including standing casualty with a spine trauma, casualty lying face-down or in recovery popsition, different lifting device, stretchers and chairs), casualty transport (including obstacles passing, stairs), situations with multiple casualties (including disasters, plan rouge, plan Orsec, chemical hazard).

Ireland[link]

In Ireland, the workplace qualification is the Occupational First Aid Certificate. The Health and Safety Authority issue the standards for first aid at work and hold a register of qualified instructors, examiners and organisations that can provide the course. A FETAC Level 5 certificate is awarded after passing a three day course and is valid for two years from date of issue. Occupational First Aiders are more qualified than Cardiac First Responders (Cardiac First Response and training on the AED is now part of the OFA course) but less qualified than Emergency First Responders but strangely Occupational First Aid is the only one of the three not certified by PHECC. Organisations offering the certificate include, Ireland's largest first aid organisation, the Order of Malta Ambulance Corps, the St John Ambulance Brigade, and the Irish Red Cross. The Irish Red Cross also provides a Practical First Aid Course aimed at the general public dealing primarily with family members getting injured. Many other (purely commercially run) organisations offer training.

Singapore[link]

In Singapore, the workplace qualification is the Occupational First Aid Certificate. The Ministry of Manpower (Singapore) issue the standards for first aid at work and qualifies first aid instructors, occupational nurses and doctors and registered safety officers as examiners and organisations that can provide the course. Instructors are required to undergo an ACTA certification, a nationally recognised training standard endorsed by the Workforce Development Agency. Workplaces with more than 25 employees are required to have certified Occupational First Aiders. The Occupational First Aid Course recently incorporated a CPR and AED segment which is accredited by the National Resuscitation Council of Singapore and is valid for 2 years. Occupational First Aiders learn more workplace related topics than Cardiac First Responders and is the industry standard in Singapore. However, they may be less qualified than EMTs.

The Netherlands[link]

In the Netherlands basic level lay firstaid training is mostly provided by specialised (commercial) first aid training companies or volunteer instructors and first aiders are mostly certified by the "Dutch Red Cross" and the foundation "Het Oranje Kruis". The foundation "LPEV" certifies mainly advanced and first responder level' firstaid training.

Medical firstaid must always be provided by certified ambulance crews, physicians and hospital staff.

United Kingdom[link]

In the UK, there are two main types of first aid courses offered. An “Emergency First Aid at Work” course typically lasts one day, and covers the basics, focusing on critical interventions for conditions such as cardiac arrest and severe bleeding, and is usually not formally assessed. A “First Aid at Work” course is usually a three-day course (two days for a re-qualification) that covers the full spectrum of first aid, and is formally assessed by recognized Health and Safety Executive assessors. Certificates for the “First Aid at Work” course are issued by the training organization and are valid for a period of three years from the date the delegate passes the course. Other courses offered by training organizations such as St. John Ambulance, St Andrew’s First Aid or the British Red Cross include Baby and Child Courses, manual handling, people moving, and courses geared towards more advanced life support, such as defibrillation and administration of medical gases such as oxygen and entonox.

The British Forces use First Aid ranging from levels 1–3, to assist the medical staff on their Ship, Squadron, Section, Base or any other purpose required. They are trained in both Military and Civilian First Aid and often utilise their knowledge in aid stricken regions around the world. First Aid is vital on board HM Ships because of the number of people in a small area and the space given to perform their task, it is also vital for the Army and Royal Marines to know basic first aid to help the survival rate of the soldiers when in combat.

United States[link]

In the United States, there is no universal schedule of First Aid levels that are applicable to all agencies that provide first aid training. Training is provided typically through the American Red Cross, but may also be completed by local fire departments and the American Heart Association (AHA) in terms of CPR. The American Red Cross, however, offers the following courses:^[11]

• CPR
  • CPR-Adult (CPR-A)
  • CPR-Child and Infant (CPR-CI)
  • CPR-Adult and Child (CPR-AC)
  • CPR-Adult, Child, and Infant (CPR-ACI)
• CPR/Automated External Defibrillator (AED)
  • CPR/AED-Adult (CPR/AED-A)
  • CPR/AED-Adult and Child (CPR/AED-AC)
  • CPR/AED for the Professional Rescuer
• First Aid
  • First Aid Basics
  • Standard First Aid
  • First Aid - Responding to Emergencies
  • Wilderness and Remote First Aid
  • Emergency Medical Response
• Specialty
  • Administering Emergency Oxygen
  • Bloodborne Pathogens Training
  • Lifeguarding (Lifeguard training)
  • Epinephrine Auto-Injector Use
  • First Responder in the Workplace training (CPR/AED/First Aid)
  • Dog, Cat, and Dog/Cat First Aid
  • Babysitter's Training
  • Instructor Certification

Red Cross training programs may vary by Chapter and season. Lay First Aid Providers in the United States are subject to Good Samaritan law protections as long as their treatment does not extend beyond training or certification. First Aid training in the United States is limited to basic life support functions needed to sustain life, and training instills the importance of activating the Emergency Medical System before beginning assistance (through the Three C's: Check, Call, Care). Training classes range from a few hours for a specific course, or several days for combination, specialty, and instructor courses. Red Cross volunteers are required to be Standard First Aid plus CPR/ACI certified (AED is encouraged but not required as of 2009), as well as passing the FEMA NIMS Introductory certification.

Specific disciplines[link]

There are several types of first aid (and first aider) which require specific additional training. These are usually undertaken to fulfill the demands of the work or activity undertaken.

• Aquatic/Marine first aid—Usually practiced by professionals such as lifeguards, professional mariners or in diver rescue, and covers the specific problems which may be faced after water-based rescue and/or delayed MedEvac.
• Battlefield first aid—This takes in to account the specific needs of treating wounded combatants and non-combatants during armed conflict.
• Hyperbaric first aid—Which may be practiced by SCUBA diving professionals, who need to treat conditions such as the bends.
• Oxygen first aid—Providing oxygen to casualties who suffer from conditions resulting in hypoxia.
• Wilderness first aid is the provision of first aid under conditions where the arrival of emergency responders or the evacuation of an injured person may be delayed due to constraints of terrain, weather, and available persons or equipment. It may be necessary to care for an injured person for several hours or days.
• Hydrofluoric Acid first aid—taught to first aiders in the chemical industry where hydrofluoric acid may be used. Instructs the first aider how to initially treat (with calcium gluconate) any skin that has been splashed with the acid.
• Mental health first aidTaught independently of physical first aid. How to support someone experiencing a mental health problem or in a crisis situation. Also how to identify the first signs of someone developing mental ill health and guide people towards appropriate help.

Symbols[link]

Although commonly associated with first aid, the symbol of a red cross is an official protective symbol of the Red Cross. According to the Geneva Conventions and other international laws, the use of this and similar symbols is reserved for official agencies of the International Red Cross and Red Crescent, and as a protective emblem for medical personnel and facilities in combat situations. Use by any other person or organization is illegal, and may lead to prosecution.

The internationally accepted symbol for first aid is the white cross on a green background shown below.

Some organizations may make use of the Star of Life, although this is usually reserved for use by ambulance services, or may use symbols such as the Maltese Cross, like the Order of Malta Ambulance Corps and St John Ambulance. Other symbols may also be used.

• 

  ISO First Aid Symbol

• 

  St. Andrew's First Aid Badge

• 

  Symbol of the Red Cross

• 

  Maltese or Amalfi Cross

• 

  Star of life

• 

  Civil defence

Conditions that often require first aid[link]

Also see medical emergency.

• Altitude sickness, which can begin in susceptible people at altitudes as low as 5,000 feet, can cause potentially fatal swelling of the brain or lungs.^[12]
• Anaphylaxis, a life-threatening condition in which the airway can become constricted and the patient may go into shock. The reaction can be caused by a systemic allergic reaction to allergens such as insect bites or peanuts. Anaphylaxis is initially treated with injection of epinephrine.
• Battlefield first aid—This protocol refers to treating shrapnel, gunshot wounds, burns, bone fractures, etc. as seen either in the ‘traditional’ battlefield setting or in an area subject to damage by large scale weaponry, such as a bomb blast.
• Bone fracture, a break in a bone initially treated by stabilizing the fracture with a splint.
• Burns, which can result in damage to tissues and loss of body fluids through the burn site.
• Cardiac Arrest, which will lead to death unless CPR preferably combined with an AED is started within minutes. There is often no time to wait for the emergency services to arrive as 92 percent of people suffering a sudden cardiac arrest die before reaching hospital according to the American Heart Association.
• Choking, blockage of the airway which can quickly result in death due to lack of oxygen if the patient’s trachea is not cleared, for example by the Heimlich Maneuver.
• Childbirth.
• Cramps in muscles due to lactic acid build up caused either by inadequate oxygenation of muscle or lack of water or salt.
• Diving disorders, drowning or asphyxiation.^[13]
• Gender-specific conditions, such as dysmenorrhea and testicular torsion.
• Heart attack, or inadequate blood flow to the blood vessels supplying the heart muscle.
• Heat stroke, also known as sunstroke or hyperthermia, which tends to occur during heavy exercise in high humidity, or with inadequate water, though it may occur spontaneously in some chronically ill persons. Sunstroke, especially when the victim has been unconscious, often causes major damage to body systems such as brain, kidney, liver, gastric tract. Unconsciousness for more than two hours usually leads to permanent disability. Emergency treatment involves rapid cooling of the patient.
• Hair tourniquet a condition where a hair or other thread becomes tied around a toe or finger tightly enough to cut off blood flow.
• Heat syncope, another stage in the same process as heat stroke, occurs under similar conditions as heat stroke and is not distinguished from the latter by some authorities.
• Heavy bleeding, treated by applying pressure (manually and later with a pressure bandage) to the wound site and elevating the limb if possible.
• Hyperglycemia (diabetic coma) and Hypoglycemia (insulin shock).
• Hypothermia, or Exposure, occurs when a person’s core body temperature falls below 33.7°C (92.6°F). First aid for a mildly hypothermic patient includes rewarming, but rewarming a severely hypothermic person could result in a fatal arrhythmia, an irregular heart rhythm.
• Insect and animal bites and stings.
• Joint dislocation.
• Poisoning, which can occur by injection, inhalation, absorption, or ingestion.
• Seizures, or a malfunction in the electrical activity in the brain. Three types of seizures include a grand mal (which usually features convulsions as well as temporary respiratory abnormalities, change in skin complexion, etc.) and petit mal (which usually features twitching, rapid blinking, and/or fidgeting as well as altered consciousness and temporary respiratory abnormalities).
• Muscle strains and Sprains, a temporary dislocation of a joint that immediately reduces automatically but may result in ligament damage.
• Stroke, a temporary loss of blood supply to the brain.
• Toothache, which can result in severe pain and loss of the tooth but is rarely life threatening, unless over time the infection spreads into the bone of the jaw and starts osteomyelitis.
• Wounds and bleeding, including lacerations, incisions and abrasions, Gastrointestinal bleeding, avulsions and Sucking chest wounds, treated with an occlusive dressing to let air out but not in.

References[link]

External links[link]

Look up first aid in Wiktionary, the free dictionary.

Wikibooks has a book on the topic of First Aid

• First Aid Guide at the Mayo Clinic
• What is CPR
• First aid from the British Red Cross - including first aid tips and first aid training information

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Look up first in Wiktionary, the free dictionary.

First or 1st is the ordinal form of the number one. First or 1st may also refer to:

• First (Grindelwald), minor summit below the Schwarzhorn in the Bernese Alps in Switzerland
• First (Kandersteg), mountain in Bernese Alps in Switzerland
• First (magazine), a Singaporean movie magazine
• First grade, in primary education
• For Inspiration and Recognition of Science and Technology (FIRST), a world-wide youth robotics competition
• First, a British undergraduate degree classification
• FirstGroup A large British transportation company operating buses, trains, coaches and trams.
• FIRST, Far Infrared and Sub-millimetre Telescope, a previous name for Herschel Space Observatory, an ESA satellite.

Music[link]

• 1st (album), by Streets
• 1st (The Rasmus EP), by The Rasmus, frequently identified as a single
• First (Baroness album)
• First (David Gates album)
• "First" (song), by Lindsay Lohan
• First., EP by Denise Ho
• The First (album), by Shinee

See also[link]

• FST (disambiguation)
• All pages beginning with "First"
• All pages with titles containing "First"
• Book:FIRST
• Category:Lists of firsts
• 1 (disambiguation)
• One (disambiguation)

This disambiguation page lists articles associated with the same title. If an internal link led you here, you may wish to change the link to point directly to the intended article.

Aid received, per capita, in 2007, in $ of Official Development Assistance per person. Note that grey countries can either be non-recipients or ones for which data is unavailable. The data were converted into dollars using exchange rates, hence may not accurately reflect the purchasing power of the foreign aid received.^[1]

In international relations, aid (also known as international aid, overseas aid, or foreign aid) is a voluntary transfer of resources from one country to another, given at least partly with the objective of benefiting the recipient country.^[2] It may have other functions as well: it may be given as a signal of diplomatic approval, or to strengthen a military ally, to reward a government for behaviour desired by the donor, to extend the donor's cultural influence, to provide infrastructure needed by the donor for resource extraction from the recipient country, or to gain other kinds of commercial access.^[3] Humanitarianism and altruism are, nevertheless, significant motivations for the giving of aid.^[4]

Aid may be given by individuals, private organisations, or governments. Standards delimiting exactly the kinds of transfers that count as aid vary. For example, aid figures may or may not include transfers for military use: to cite one instance, the United States included military assistance in its aid figure until 1957 but no longer does.^[5] The most widely used measure of aid, "Official Development Assistance" (ODA) is such a figure. It is compiled by the Development Assistance Committee of the Organisation for Economic Co-operation and Development. The United Nations, the World Bank, and many scholars use the DAC's ODA figure as their main aid figure because it is easily available and reasonably consistently calculated over time and between countries.^[6] The DAC consists of 22 of the wealthiest Western industrialised countries plus the EU; it is a forum in which they coordinate their aid policies.

Types[link]

Humanitarian aid[link]

Humanitarian aid or emergency aid is rapid assistance given to people in immediate distress by individuals, organisations, or governments to relieve suffering, during and after man-made emergencies (like wars) and natural disasters. The term often carries an international connotation, but this is not always the case. It is often distinguished from development aid by being focussed on relieving suffering caused by natural disaster or conflict, rather than removing the root causes of poverty or vulnerability.

U.S. Soldiers unload humanitarian aid for distribution to the town of Rajan Kala, Afghanistan, Dec. 5, 2009

The provision of humanitarian aid or humanitarian response consists of the provision of vital services (such as food aid to prevent starvation) by aid agencies, and the provision of funding or in-kind services (like logistics or transport), usually through aid agencies or the government of the affected country. Humanitarian aid is distinguished from humanitarian intervention, which involves armed forces protecting civilians from violent oppression or genocide by state-supported actors.

The Geneva Conventions give a mandate to the International Committee of the Red Cross and other impartial humanitarian organizations to provide assistance and protection of civilians during times of war. The ICRC, has been given a special role by the Geneva Conventions with respect to the visiting and monitoring of prisoners of war.

The United Nations Office for the Coordination of Humanitarian Affairs (OCHA) is mandated to coordinate the international humanitarian response to a natural disaster or complex emergency acting on the basis of the United Nations General Assembly Resolution 46/182.

The Sphere Project handbook, Humanitarian Charter and Minimum Standards in Disaster Response, which was produced by a coalition of leading non-governmental humanitarian agencies, lists the following principles of humanitarian action:

1. The right to live with dignity.
2. The distinction between combatant and non-combatants.
3. The principle of non-refoulement.

Development aid[link]

Official Development Assistance (ODA) measured in GNI in 2009. Source: OECD

Development aid is aid given by developed countries to support development in general which can be economic development or social development in developing countries. It is distinguished from humanitarian aid as being aimed at alleviating poverty in the long term, rather than alleviating suffering in the short term.

Official Development Assistance (ODA), mentioned above, is a commonly used measure of developmental aid. Development aid is given by governments through individual countries' international aid agencies and through multilateral institutions such as the World Bank, and by individuals through development charities such as ActionAid, Caritas, Care International or Oxfam.

The offer to give development aid has to be understood in the context of the Cold War. The speech in which Harry Truman announced the foundation of NATO is also a fundamental document of development policy:

In addition, we will provide military advice and equipment to free nations which will cooperate with us in the maintenance of peace and security. Fourth, we must embark on a bold new program for making the benefits of our scientific advances and industrial progress available for the improvement and growth of underdeveloped areas. More than half the people of the world are living in conditions approaching misery. Their food is inadequate. They are victims of disease. Their economic life is primitive and stagnant. Their poverty is a handicap and a threat both to them and to more prosperous areas. For the first time in history, humanity possesses the knowledge and skill to relieve the suffering of these people.

Sources[link]

Aid from various sources can reach recipients through bilateral or multilateral delivery systems. Bilateral refers to government to government transfers. Multilateral institutions, such as the World Bank or UNICEF, pool aid from one or more sources and disperse it among many recipients.

• Official Development Assistance (ODA): Development aid provided to developing countries (on the "Part I" list) with the clear aim of economic development
• Official Aid (OD): Development aid provided to developed countries (on the "Part II" list) and international organizations
• Other Official Flows (OOF): Aid which does not fall into the other two categories, either because it is not aimed at development, or it consists of more than 75% loan (rather than grant).

Aid is often pledged at one point in time, but disbursements (financial transfers) might not arrive until later.

Private giving[link]

Private giving includes aid from charities, philanthropic organizations or businesses to recipient countries or programs within recipient counties.

What is excluded[link]

Most monetary flows between nations are not counted as aid. These include market based flows such as foreign direct investments and portfolio investments. Remittances from migrant workers to their home countries are not counted in aid numbers even though, by volume, it is twice as large as what is counted as aid.^[7] Additionally, military support is not counted.

Receiving aid[link]

Types[link]

• Project aid: Aid is given for a specific purpose e.g. building materials for a new school.
• Programme aid: Aid is given for a specific sector e.g. funding of the education sector of a country.
• Budget support: A form of Programme Aid that is directly channelled into the financial system of the recipient country.
• Sector-wide Approaches (SWAPs): A combination of Project aid and Programme aid/Budget Support e.g. support for the education sector in a country will include both funding of education projects (like school buildings) and provide funds to maintain them (like school books).
• Technical assistance: Educated personnel, such as doctors are moved into developing countries to assist with a program of development. Can be both programme and project aid.
• Food aid: Food is given to countries in urgent need of food supplies, especially if they have just experienced a natural disaster. Food aid can be provided by importing food from the donor, buying food locally, or providing cash.
• International research, such as research that went into the green revolution and many vaccines.

Aid conditionality[link]

A major proportion of aid from donor nations is tied, mandating that a receiving nation spend on products and expertise originating only from the donor country. ^[8] For example, Eritrea is forced to spend aid money on foreign goods and services to build a network of railways even though it is cheaper to use local expertise and resources.^[8] US law requires food aid be spent on buying food at home, instead of where the hungry live, and, as a result, half of what is spent is used on transport.^[9] Oxfam America and American Jewish World Service report that reforming US food aid programs could extend food aid to an additional 17.1 million people around the world.^[10]

The World Bank and the International Monetary Fund, as primary holders of developing countries' debt, attach structural adjustment conditionalities to loans which generally include the elimination of state subsidies and the privatization of state services. For example, the World Bank presses poor nations to eliminate subsidies for fertilizer even while many farmers cannot afford them at market prices.^[11] In the case of Malawi, almost five million of its 13 million people used to need emergency food aid. However, after the government changed policy and subsidies for fertilizer and seed were introduced, farmers produced record-breaking corn harvests in 2006 and 2007 as production leaped to 3.4 million in 2007 from 1.2 million in 2005, making Malawi a major food exporter.^[11] In the former Soviet states, the reconfiguration of public financing in their transition to a market economy called for reduced spending on health and education, sharply increasing poverty.^[12][13][14]

Criticism of aid[link]

Aid is seldom given from motives of pure altruism; for instance it is often given as a means of supporting an ally in international politics. It may also be given with the intention of influencing the political process in the receiving nation. Whether one considers such aid helpful may depend on whether one agrees with the agenda being pursued by the donor nation in a particular case. During the conflict between communism and capitalism in the twentieth century, the champions of those ideologies, the Soviet Union and the United States, each used aid to influence the internal politics of other nations, and to support their weaker allies. Perhaps the most notable example was the Marshall Plan by which the United States, largely successfully, sought to pull European nations toward capitalism and away from communism. Aid to underdeveloped countries has sometimes been criticized as being more in the interest of the donor than the recipient, or even a form of neocolonialism.^[15]

Marshall Plan aid to Germany, West Berlin, 1949

S.K.B'. Asante lists some specific motives a donor may have for giving aid: defense support, market expansion, foreign investment, missionary enterprise, cultural extension.^[16] In recent decades, aid by organizations such as the International Monetary Fund and the World Bank has been criticized as being primarily a tool used to open new areas up to global capitalists, and being only secondarily, if at all, concerned with the wellbeing of the people in the recipient countries.

Besides criticism of motive, aid may be criticized simply on the grounds that it is not effective: i.e., it did not do what it was intended to do or help the people it was intended to help. This is essentially an economic criticism of aid. The two types of criticism are not entirely separate: critics of the ideology behind a piece of aid are likely to see it as ineffective; and indeed, ineffectiveness must imply some flaws in the ideology. Statistical studies have produced widely differing assessments of the correlation between aid and economic growth, and no firm consensus has emerged to suggest that foreign aid generally does boost growth. Some studies find a positive correlation, but others find either no correlation or a negative correlation. In the case of Africa, Asante (1985) gives the following assessment:

Summing up the experience of African countries both at the national and at the regional levels it is no exaggeration to suggest that, on balance, foreign assistance, especially foreign capitalism, has been somewhat deleterious to African development. It must be admitted, however, that the pattern of development is complex and the effect upon it of foreign assistance is still not clearly determined. But the limited evidence available suggests that the forms in which foreign resources have been extended to Africa over the past twenty-five years, insofar as they are concerned with economic development, are, to a great extent, counterproductive.^[17]

The economist William Easterly and others have argued that aid can often distort incentives in poor countries in various harmful ways. Aid can also involve inflows of money to poor countries that have some similarities to inflows of money from natural resources that provoke the resource curse.^[18][19]

Many individuals^[20] and organizations criticize U.S. Aid. Emergency funds from the International Monetary Fund (IMF) and World Bank, for instance, are linked to a wide range of free-market policy prescriptions that some argue interfere in a country's sovereignty. Policy prescriptions from outsiders can do more harm as they might not fit the local environment. The IMF can be good at helping countries over a short problematic financial period, but for poor countries with long lasting issues it can cause harm.^{[citation needed]} In his book The White Man's Burden, Easterly argued that if the IMF only gave adjustment loans to countries that can repay it, instead of forgiving debts or lending repetitively even if conditions are not met, it would maintain its credibility.

In addition to the above criticisms, the logistics in which aid delivery occurs can be problematic. An earthquake in 2003 in Bam, Iran left tens of thousands of people in need of disaster zone aid. Although aid was flown in rapidly, regional belief systems, cultural backgrounds and even language seemed to have been omitted as a source of concern. Items such as religiously prohibited pork, and non-generic forms of medicine that lacked multilingual instructions came flooding in as relief. An implementation of aid can easily be problematic, causing more problems than it solves.^[21]

James Shikwati, a Kenyan economist, has argued that foreign aid causes harm to the recipient nations, specifically because aid is distributed by local politicians, finances the creation of corrupt government such as that led by Dr Fredrick Chiluba in Zambia bureaucracies, and hollows out the local economy. In an interview in Germany's Der Spiegel magazine, Shikwati uses the example of food aid delivered to Kenya in the form of a shipment of corn from America. Portions of the corn may be diverted by corrupt politicians to their own tribes, or sold on the black market at prices that undercut local food producers. Similarly, Kenyan recipients of donated Western clothing will not buy clothing from local tailors, putting the tailors out of business.^[22] In an episode of 20/20, John Stossel demonstrated the existence of secret government bank accounts which concealed foreign aid money destined for private purposes.

Some believe that aid is offset by other economic programs such as agricultural subsidies. Mark Malloch Brown, former head of the United Nations Development Program, estimated that farm subsidies cost poor countries about US$50 billion a year in lost agricultural exports:

"It is the extraordinary distortion of global trade, where the West spends $360 billion a year on protecting its agriculture with a network of subsidies and tariffs that costs developing countries about US$50 billion in potential lost agricultural exports. Fifty billion dollars is the equivalent of today's level of development assistance."^[23][24]

Some have argued that the major international aid organizations have formed an aid cartel.^[25]

In response to aid critics, a movement to reform U.S. foreign aid has started to gain momentum. In the United States, leaders of this movement include the Center for Global Development, Oxfam America, the Brookings Institution, InterAction, and Bread for the World. The various organizations have united to call for a new Foreign Assistance Act, a national development strategy, and a new cabinet-level department for development.^[26]

Beyond aid[link]

As a result of these numerous criticisms, other proposals for supporting developing economies and poverty stricken societies. Some analysts, such as researchers at the Overseas Development Institute, argue that current support for the developing world suffers from a policy incoherence and that while some policies are designed to support the third world, other domestic policies undermine its impact,^[27] examples include:

• encouraging developing economies to develop their agriculture with a focus on exports is not effective on a global market where key players, such as the US and EU, heavily subsidise their products
• providing aid to developing economies' health sectors and the training of personnel is undermined by migration policies in developed countries that encourage the migration of skilled health professionals

One measure of this policy incoherence is the Commitment to Development Index (CDI) published by the Center for Global Development . The index measures and evaluates 22 of the world's richest countries on policies that affect developing countries, in addition to simply aid. It shows that development policy is more than just aid; it also takes into account trade, investment, migration, environment, security, and technology.

Thus, some states are beginning to go Beyond Aid and instead seek to ensure there is a policy coherence, for example see Common Agricultural Policy reform or Doha Development Round. This approach might see the nature of aid change from loans, debt cancellation, budget support etc., to supporting developing countries. This requires a strong political will, however, the results could potentially make aid far more effective and efficient.^[27]

Aid inefficiencies and possible improvements[link]

Aid destinations[link]

It is true that aid is rarely given for motives of pure altruism. However, it is important to look at where aid goes. For example, “only about one fifth of U.S. aid goes to countries classified by the OECD as ‘least developed.’”^[28] This “pro-rich” trend is not unique to the United States.^[28][29] According to Collier, “the middle income countries get aid because they are of much more commercial and political interest than the tiny markets and powerlessness of the bottom billion.”^[30] What this means is that, at the most basic level, aid is not targeting the most extreme poverty.^[28][29]

The form of aid must also be considered. The World Bank, until recently, issued only loans, meaning that the country must repay both the loan and the interest rates. In contrast, the European Commission issues grants, which countries need not worry about paying back. This means that “loans have been going to the poorest countries and the grants to the middle-income countries.”^[30]

Furthermore, consider the breakdown, where aid goes and for what purposes. In 2002, total gross foreign aid to all developing countries was $76 billion. Dollars that do not contribute to a country’s ability to support basic needs interventions are subtracted. Subtract $6 billion for debt relief grants. Subtract $11 billion, which is the amount developing countries paid to developed nations in that year in the form of loan repayments. Next, subtract the aid given to middle income countries, $16 billion. The remainder, $43 billion, is the amount that developing countries received in 2002. But only $12 billion went to low-income countries ($15 billion for all developing countries) in a form that could be deemed budget support for basic needs.^[29]

When aid is given to the Least Developed Countries who have good governments and strategic plans for the aid, it is thought that it is more effective.^[29]

Aid outcomes and implications[link]

The basic criticism of aid is that it neither goes where it was intended nor helps those intended. According to Collier, there are four known traps that contribute this problem. The first such trap is known as the conflict trap. Aid should not be used to finance military endeavors. It is difficult to “design aid in such a way that it works even in the environments of poor governance and poor policy that are most at risk of conflict.”^[30] The second trap is called the natural resource trap. Countries that are resource rich already have a large volume of capital flowing into their economies. However, it is not being used to its potential. The third trap occurs when a country is entirely landlocked, making it difficult for the country to engage in global trade.^[30]

The fourth trap is that of bad governance. However, “there are three ways in which aid can potentially help turnarounds: incentives, skills, and reinforcement.”^[30] Policy conditionalities, or structural adjustments, were reservations put on aid until a government agreed to aid implemented in the 1980s. This did not work. Aid needs to somehow provide incentives for giving the people power. Power needs to be transferred from the governments to the people.^[30] Aid should be restructured in order to allow for skills building in country. According to Collier, “technical assistance is not negligible – money spent on countries with the skilled people who constitute technical assistance is a quarter of total aid flows.”^[30] The problem is not that too little money is being provided, rather that technical assistance is not country specific. Aid is also given as budget support, reinforcement for failing states. There is an opportune moment for assisting failing states but it must be done at the right time. Aid cannot be continually poured into failing states and be expected to produce a turnaround. However if aid is given at the opportune political moment, it can support turnarounds. Collier suggests that when that moment occurs “pour in the technical assistance as quickly as possible to help implement reform” and “then, after a few years, start pouring in the money for the government to spend.”^[30]

Actual impact[link]

Peter Singer argues that over the last three decades, “aid has added around one percentage point to the annual growth rate of the bottom billion.” He argues that this has made the difference between “stagnation and severe cumulative decline.”^[28] Aid can make progress towards reducing poverty worldwide, or at least help prevent cumulative decline.

Improving the economic efficiency of aid[link]

Currently, donor institutions make proposals for aid packages to recipient countries. The recipient countries then make a plan for how to use the aid based on how much money has been given to them. Alternatively, NGO's receive funding from private sources or the government, and then implement plans to end their specific issues. In the views of many scholars, this system is inherently ineffective.^[29] If we hope to eliminate poverty, we must reexamine how we distribute funding, and how we attack problems.

According to Sachs, we should redefine how we think of aid. The first step should be to learn what developing countries hope to accomplish and how much money they need to accomplish those goals. Goals should be made with the Millennium Development Goals in mind for these furnish real metrics for providing basic needs. The “actual transfer of funds must be based on rigorous, country-specific plans that are developed through open and consultative processes, backed by good governance in the recipient countries, as well as careful planning and evaluation.”^[29]

Possibilities are also emerging as some developing countries are experiencing rapid economic growth, they are able to provide their own expertise gained from their recent transition. This knowledge transfer can be seen in donors, such as Brazil, whose $1 billion in aid outstrips that of many traditional donors.^[31] Brazil provides most of its aid in the form of technical expertise and knowledge transfers.^[31] This has been descried by some observers as a 'global model in waiting'.^[32]

Various academic theories[link]

Since the 1960s, improving the efficiency of foreign aid has been a common topic of academic research. There is debate on whether foreign aid is efficacious, but for the purposes of this article we will ignore that. Given that schema, a common debate is over which factors influence the overall economic efficiency of foreign aid. Indeed, there is debate about whether aid impact should be measured empirically at all, but again, we will limit our scope to increasing the economic efficiency.

Philosophy[link]

At the forefront of the aid debate has been the conflict between professor William Easterly of New York University ^[33] and his ideological opposite, Jeffrey Sachs, from Columbia University. Easterly advocates the "searcher's" approach, while Sachs advocates a more top down, broad planned approach. We will discuss both of these at length.^[34]

“Searchers Approach”[link]

William Easterly offers a nontraditional, and somewhat controversial “searching” approach to solving poverty, as opposed to the “planned” approach in his famous critique of the more traditional Owen/Sachs, The White Man’s Burden. Traditional poverty reduction, Easterly claims is based on the idea that we know what is best for those countries, which are impoverished. He claims that they know what’s best. Having a top down “master plan,” he claims, is inefficient. His alternative, called the “Searchers” approach, uses a bottom up strategy. That is, this approach starts by surveying the poor in the countries in question, and then tries to directly aid individuals, rather than governments. Local markets are a key incentive structure. The primary example is of Mosquito nets in Malawi. In this example, an NGO sells Mosquito nets to rich Malawians, and uses the profits to subsidize cheap sales to the impoverished. Hospital nurses are used as middle-women, profiting a few cents on every net sold to a patient. This incentive structure has seen the usage of nets in Malawi spike over 40% in less than 7 years.^[35]

Aspects of “Searcher’s Approach”[link]

Bottom up philosophy[link]

One of the central tenets in Easterly’s approach is a more bottom up philosophy of aid. This applies not only to the identification of problems, but to the actual distribution of capital to the areas in need. In effect, Easterly would have countries go to the area which needed aid, collect information about the problem, find out what the population wanted, and then work from there. In keeping with this, funds would also be distributed from the bottom up, rather than being given to a specific government.^[35]

Utilize aid organizations, and local frameworks[link]

Easterly also advocates working through currently existing Aid organizations, and letting them compete for funding. Utilizing preexisting national organizations and local frameworks would not only help give target populations a voice in implementation and goal setting, but is more efficient economically. Easterly argues that the preexisting frameworks already "know" what the problems are, as opposed to outside NGOs who tend to "guess". ^[35]

Aid individuals, not governments[link]

Easterly strongly discourages aid to government as a rule. He believes, for several reasons, that aid to small “bottom up” organizations and Individual groups is a better philosophy than to large governments.^[35]

Independent evaluation[link]

Easterly states that for far too long, inefficient aid organizations have been funded, and that this is a problem. The current system of evaluation for most aid organizations is internal. Easterly claims that the process is biased because organizations have a large incentive to represent their progress in a positive light. What he proposes as an alternative is an independent auditing system for aid organizations. Before receiving funding, the organization would state their goals and how they expect to measure and achieve them. If they do not meet their goals, Easterly proposes we shift our funding to organizations who are successful. This would prompt organizations to either become efficient, or obsolete.^[35]

Compartmentalized goals[link]

Easterly believes that aid goals should be small. In his opinion, one of the main failings of aid lies in the fact that we create large, utopian lists of things we hope to accomplish, without the means to actually see them to fruition. Rather than establish a utopian vision for a particular country, Easterly insists that we shift our focus to the most basic needs and improvements.If we feed, clothe, vaccinate, build infrastructure, and support markets, the macroscopic results will follow.^[35]

Use the market[link]

The “Searching Approach” is intrinsically tied to the market. Easterly claims that the only way for poverty to truly end is for the poor to be given the capability to lift themselves out of poverty, and then for it to happen. Philosophically, this sounds like the traditional “bootstrap” theory, but it isn’t. What he says is that the poor should be given the fiscal support to create their market, which would give them the ability to become self reliant in the future.^[35]

Ideas[link]

In the end of his book, Easterly proposes a voucher system for foreign aid. The poor would be distributed a certain amount of vouchers, which would act as currency, redeemable to aid organizations for services, medicines, and the like. These vouchers would then be redeemed by the aid organizations for more funding. In this way, the aid organization would be forced to compete, if by proxy.^[35]

Proscriptive "Ladder Approach"[link]

Sachs presents a near dichotomy to Easterly. Sachs presents a broad, proscriptive solution to poverty. In his book, The End of Poverty, he explains how throughout history, countries have ascended from poverty by following a relatively simple model. First, you promote agricultural development, then industrialize, embrace technology, and finally become modern. This is the standard “western” model of development that has been followed by countries such as China and India. Sachs main idea is that there should have a broad analytical “checklist” of things a country must attain before it can reach the next step on the ladder to development. Western nations should donate a percentage of their GDP as determined by the UN, and pump money into helping impoverished countries climb the ladder. Sachs insists that if followed, his strategy would eliminate poverty by 2025.

^[36]

Top down[link]

Sachs advocates using a top down methodology, utilizing broad ranging plans developed by external aid organizations like the UN and World Bank. To Sachs, these plans are essential to a coherent and timely eradication of poverty.He surmises that if donor and recipient countries follow the plan, they will be able to climb out of poverty.

^[36]

Use external framework[link]

Part of Sachs’ philosophy includes strengthening the International Monetary Fund, World Bank, and the United Nations. If those institutions are given the power to enact change, and freed from mitigating influences, then they will be much more effective. Sachs does not find fault in the international organizations themselves. Instead, he blames the member nations who compose them. The powerful nations of the world must make a commitment to end poverty, then stick to it.

^[36]

Aid through existing governments[link]

Sachs believes it is best to empower countries by utilizing their existing governments, rather than trying to circumnavigate them. He remarks that while the corruption argument is logically valid in that corruption harms the efficiency of aid, levels of corruption tend to be much higher on average for countries with low levels of GDP. He contends that this hurdle in government should not disqualify entire populations for much needed aid from the west.

^[36]

Self evaluation[link]

Sachs does not see the need for independent evaluators, and sees them as a detractor to proper progress. He argues that many facets of aid cannot be effectively quantified, and thus it is not fair to try to put empirical benchmarks on the effectiveness of aid.^[36]

Optimism[link]

Sachs’ view makes it a point to attack and attempt to disprove many of the ideas that the more “pessimistic” Easterly stands on.

First, he points to economic freedom. One of the common threads of logic In aid is that countries need to develop economically in order to rise from Poverty. On this, there is not a ton of debate. However, Sachs contends that Easterly, and many other neo-Liberal economists believe high levels of Economic freedom in these emerging markets is almost a necessity to Development. Sachs himself does not believe this. He cites the lack of Correlation between the average degrees of Economic Freedom in countries And their yearly GDP growth, which in his data set is completely Inconclusive.

Also, Sachs contends that democratization is not an integral part of having Efficient aid distribution. Rather than attach strings to our aid dollars, or only Working with democracies or “good governments”, Sachs believes we should Consider the type of government in the needy country as a secondary Concern.

Sachs’ entire approach stands on the assertion that abject poverty could be Ended worldwide by 2025.^[36]

Economic efficiency[link]

David Dollar[link]

Dollar/Collier showed that current allocations of aid are allocated inefficiently. They came to the conclusion that aid money is given in many cases as an incentive to change policy, and for political reasons, which in many cases can be less efficient than the optimal condition. They agree that bad policy is detrimental to economic growth, which is a key component of poverty reduction, but have found that aid dollars do not significantly incentivize governments to change policy. In fact, they have negligible impact. As an alternative, Dollar proposes that aid be funneled more towards countries with “good” policy and less than optimal amounts of aid for their massive amounts of poverty. With respect to “optimal amounts” Dollar calculated the marginal productivity of each additional dollar of foreign aid for the countries sampled, and saw that some countries had very high rates of marginal productivity (each dollar went further), while others [with particularly high amounts of aid, and lower levels of poverty] had low [and sometimes negative] levels of marginal productivity. In terms of economic efficiency, aid funding would be best allocated towards countries whose marginal productivities per dollar were highest, and away from those countries who had low to negative marginal productivities. The conclusion was that while an estimated 10 million people are lifted from poverty with current aid policies, that number could be increased to 19 million with efficient aid allocation.^[37]

Dalgaard[link]

In a followup study to Collier, Dalgaard finds that regardless of policies and utility, aid seems to be less efficient per dollar in the tropics. He states that aid dollars are likely to be just as effective anywhere, so there must be a mitigating externality that is not being accounted for.^[38]

“New Conditionality”[link]

New Conditionality is the term used in a paper to describe somewhat of a compromise between Dollar and Hansen. Paul Mosely describes how policy is important, and that aid distribution is improper. However, unlike Dollar, “New Conditionality” claims that the most important factors in efficiency of aid are income distributions in the recipient country and corruption.^[39]

McGillivray[link]

One of the problems in foreign aid allocation is the marginalization of the fragile state. The fragile state, with its high volatility, and risk of failure scares away donors. The people of those states feel harm and are marginalized as a result. Additionally, the fate of neighboring states is important, as economies of the directly adjacent states to those impoverished, volatile “fragile states” can be negatively impacted by as much as 1.6% of their GDP per year. This is no small figure. McGillivray advocates for the reduced volatility of aid flows, which can only be attained through analysis and coordination.^[40]

Beynon[link]

Beynon revisits Collier/Dollar’s “efficient aid allocation” and finds much of the same results, although he believes that the model needs to be more robust, with more samplings, and take into account other Millennium Development Goals.^[41]

Aid conditionality[link]

Aid often comes with conditions on its allocation. This is called Aid Conditionality. The two types of conditionality are Outcome and Process based conditionality. Outcome conditionality ties aid to a certain goal, while process conditionality ties aid to a certain method of implementation. These two forms of conditionality are often seen together. The problem with aid conditionality is that it not only restricts the local legislatures in how they shape their own country, but often removes local populations from the goal setting and decision making process entirely.^[42]

Academic research has shown that in many instances, aid is conditionally tied due to political motives, rather than notions of proper policy and implementation.

The European Union double standard of trade policy mentioned above is more illustrated in its trade with Latin America. In their April 2002 publication,Oxfarm Report reveals that aid tied to trade Liberalization by the donor countries such as the EU with the aim of achieving economic objective is becoming detrimental to developing countries.For example, the EU subsidizes its agricultural sectors in the expense of Latin America who must liberalize trade in order to qualify for aid. Latin America having, a comparative advantage on agriculture and mainly forms its export sector losts $ 4bn annually due to the EU farm subsidy policies. The aid money actually, instead of being used to finance other development infrastructure, ends up being used to fund terms of trade deficit brought about by trade liberalization. This inequalities and many others imposed upon developing countries have actually benefited the donor rather than the recipient.This cases clearly illustrate the evolution of development aid assistance from providing financial resource to fuel development to being a foreign policy tool used by donor countries to promote their domestic interests. while this can be considered controversial issues, addressing them adequately may help attain some effectiveness in development aid assistance goals.

Aid and UNSC votes[link]

Axel Dreher showed that over the period 1951-2004, there was a robust positive relationship between United Nations Security Council membership and participation in Internation Monetary Fund programs. Additionally, conditions placed on Security Council member nations' aid are lower in number and severity. ^[43] Member nations of the UNSC received on average .8 more World Bank loans per year. ^[44]

Aid conditionality and good governance[link]

Seemingly in support of Bill Easterly's searcher's approach, Carlos Santiso found evidence that conditionality is quite harmful to development, and advocates a "radical approach in which donors cede control to the recipient country".

Santiso also argues that neither good governance or democracy is sustainable without the other. ^[45]

See also[link]

• Debt relief
• Disability aid abroad
• Global Food Security Act of 2009
• International Aid Transparency Initiative
• Transparency International
• United States foreign aid

Notes and references[link]

Further reading[link]

• Moyo, Dambisa (2010). Dead Aid: Why Aid is Not Working and How There is Another Way for Africa. Penguin. ISBN 978-0-14-103118-7. 
• Riddell, Roger C. (2008). Does Foreign Aid Work?. Oxford University Press. ISBN [[Special:BookSources/97801995444462|97801995444462]]. 
• Banerjee, Abhijit Vinayak (2007). Making Aid Work. The MIT Press. ISBN 978-0-262-02615-4. 
• Calderisi, Robert (2006). The Trouble with Africa: Why Foreign Aid Isn't Working. Macmillan. ISBN 1-4039-7125-0. 
• Easterly, William (2006). The White Man's Burden: Why the West's Effort to Aid the Rest Have Done So Much Ill and So Little Good. Penguin. ISBN 1-59420-037-8. 
• Lancaster, Carol; Ann Van Dusen (2005). Organizing Foreign Aid: Confronting the Challenges of the 21st Century. Brookings Institution Press. ISBN 0-8157-5113-3. 
• Oxfam America (2008). Smart Development: Why US foreign aid demands major reform. Oxfam America, Inc.. http://www.oxfamamerica.org/newsandpublications/publications/briefing_papers/smart-development. 
• Sogge, David (2002). Give and Take: What's the Matter with Foreign Aid?. Zed Books. ISBN 1-84277-069-1. 
• [5] The cartel of good intentions, Foreign Policy, Washington, Jul/Aug 2002, Authors: William Easterly, Issue: 131, Pagination: 40-49, ISSN: 00157228

External links[link]

Mr. Bean is a British comedy television programme series of 14 half-hour episodes written by and starring Rowan Atkinson as the title character. Different episodes were also written by Robin Driscoll, Richard Curtis and one by Ben Elton. The pilot episode was broadcast on ITV on 1 January 1990, with the last television episode, "Goodnight Mr. Bean" broadcast on 31 October 1995.^[2] The final episode, "Hair by Mr. Bean of London", was a video exclusive released on 15 November 1995, but not broadcast in the UK until 2006.

Based on a character originally developed by Atkinson while he was studying for his master's degree at Oxford University, the series follows the exploits of Mr. Bean, described by Atkinson as "a child in a grown man's body", in solving various problems presented by everyday tasks and often causing disruption in the process.^[3] Bean rarely speaks, and the largely physical humour of the series is derived from his interactions with other people and his unusual solutions to situations. The series was influenced by physical performers such as Jacques Tati and comic actors from silent films.^[3]

During its five-year run, the series gained large UK audience figures, including 18.74 million for the 1991 episode "The Trouble With Mr. Bean".^[4] The series has been the recipient of a number of international awards, including the Rose d'Or. The show has been sold in 245 territories worldwide, and has inspired an animated cartoon spin-off and two feature films.^[5]

Origins and influences[link]

The character of Mr. Bean was developed while Atkinson was studying for his master's degree at Oxford University. A sketch featuring the character was performed at the Edinburgh Fringe in the early 1980s.^[6] A similar character called Robert Box, played by Atkinson, appeared in the one-off 1979 ITV sitcom Canned Laughter, which also featured routines used in the 1997 film Bean.^[7] In 1987, one of Mr. Bean's earliest appearances occurred at the "Just For Laughs" comedy festival in Montreal, Quebec, Canada. When programme co-ordinators were scheduling Atkinson into the festival program, Atkinson insisted that he perform on the French-speaking bill rather than the English-speaking program. Having no French dialogue in his act at all, program co-ordinators could not understand why Atkinson wanted to perform on the French bill. As it turned out, Atkinson's act at the festival was a test platform for the Mr. Bean character and Atkinson wanted to see how the silent character's physical comedy would fare on an international stage with a non-English speaking audience.^[8]

The name of the character was not decided until after the first programme had been produced, with a number of other vegetable-influenced names, such as "Mr. Cauliflower", being explored.^[9] Atkinson cited the earlier comedy character Monsieur Hulot, created by French comedian and director Jacques Tati, as an influence on the character.^[10] Stylistically, Mr. Bean is also very similar to early silent films, relying purely upon physical comedy, with Mr. Bean speaking very little dialogue (although like other live-action TV series of the time, it features a laugh track). This has allowed the series to be sold worldwide without any significant changes to dialogue.^[8][11]