A pig scavenges in the street in one of the 11 official slums in Freetown
By Mike Thomson
in Sierra Leone
Last year more than $40bn worth of aid was spent in Africa alone. Over the last four decades that figure has quadrupled. Aid agencies, or NGO's around the world are now thought to employ as many as 300,000 people. Some, like Today programme guest Editor and Oxfam Ambassador, actor Colin Firth, are now asking what is being achieved with all this cash.
It's not hard to see where the money goes when it comes to dealing with terrible earthquakes like the one in Haiti last January that killed 230,000 and made around 1.5 million more homeless.
The same is true when it comes to the Asian tsunami and Pakistan floods. The sheer scale of such disasters and the desperate need for help before people die makes emergency aid essential.
But, what about in the years that follow? How much improvement has international development aid brought to peoples lives after the immediate threat is over?
Journalist and the author of a book on aid, Linda Polman, believes much aid goes to the wrong people in the wrong places and that more aid projects fail than succeed.
She insists that some do more harm than good by spawning dependency cultures and fuelling corrupt governments. She concludes that the developing world might actually be better off if aid workers stayed at home.
To see if such criticisms add up at all I have travelled to Sierra Leone which has received more than £100m pounds in aid from Britain since the end of its brutal civil war in 2002.
Walking around one of the 11 official slums in its capital, Freetown, I do find it difficult, initially at least, to see where all the money has gone.
Densely-packed shacks, some made of little more than old tyres, plastic sheeting and rusting corrugated iron are what people here call home. Open sewers crisscross dirty, narrow walkways and pigs sift through the filthy rubbish that seems to be everywhere.
To my left a ramshackle toilet on stilts hangs over stagnating brown water that is supposed to be a river. Health care in areas like this is almost non-existent and child mortality startlingly high.
Free healthcare has helped many people, like this pregnant woman. But will it last?
But, things do look up a little when I walk into a clinic part-funded by the charity, Save The Children. A local spokesman for the organisation tells me how work here has saved many children's lives after treating them for potentially killer conditions like diarrhoea, malaria and respiratory diseases.
A short distance away representatives from Oxfam have promised locals that they will soon be providing them with a toilets, complete with a proper sewage system. People here tell me that at present sewage seeps into their homes ever time heavy rains causes the stinking nearby river to overflow.
There is also evidence of valuable do-gooding at a children's hospital near the centre of Freetown. In a move sponsored by Britain's Department for International Development (DFID) health care for pregnant mothers and children under five was made free last April.
A pregnant mother I talked to tells me how she lost her first baby last year after being unable to pay for medical help when she fell ill. Now she sits waiting to have her next baby with all the medical assistance she might need, all free at hand.
Life is complicated though. Before I leave I ask an enthusiastic young doctor if the hospital is usually this crowded. "Not before free health care came." he tells me. "Now it's hard to cope."
The problem is that while donor countries have been giving with one hand the money to help finance free health care, they have been taking with the other. I am told that 80% of Sierra Leone's 's qualified doctors have been seduced by cheque waving western hospitals.
Generally speaking the people are not interested in doing any work.
University lecturer Patrick Ntui Nkom
Then there is the matter of sustainability in the long term. So few people pay taxes in Sierra Leone that the government here can hardly afford to pay for anything. Unless that improves dramatically, or donors continue to pay the bills for ever, this free health care looks unlikely to last.
Agriculture here presents a similar picture. Donor money has supplied brand new tractors and combine harvesters. The trouble is that, while these enable local farmers to grow all they need to feed the nation, much of the produce rots on the ground because of poor storage facilities and transportation problems.
Not only that but the former Governor General of Sierra Leone's Central Bank, Dr JD Ojes, says such machinery is incompatible with many small scale farms here and few farmers can afford the diesel or maintenance charges to run them anyway.
All this seemed less surprising when the country's Minister for Agriculture, Joseph Sam Sesay, told me the problems he has with some of his staff: "Even when you give them a clear directive as to what to do, they either don't do it or they come back more confused."
To help improve situations like this DFID and members of the Office for Tony Blair organisation have installed advisors in many government ministries here. They do seem to have good relationships with the ministers and staff concerned. Though, presumably, all this costs money too.
One worry that has continued to grow since I arrived here is what years of aid has been doing to the local spirit of enterprise.
This concern grew after the head of a small Dutch NGO told me what has happened at some of the "enterprise classes" her organisation runs. Some people here, she said, will only learn if you pay them. She went on to tell me that on one occasion when she refused to do so, she and her colleagues were attacked.
People rush for free mosquito nets at Freetown's children's hospital
"Nigerian academic, Patrick Ntui Nkom, who lectures at Freetown's Njala University, believes such attitudes are widespread here and stem from people being given something for nothing for too long.
"Generally speaking the people are not interested in doing any work." he told me.
The moment you come here and set up an establishment and employ civilians, you are going to have problems because they are lukewarm to work. Aid has been coming and it's given them a culture of having to wait for aid."
So, what is going to happen, given attitudes like that, when aid agencies finally leave this country? Will all the donor-funded combine harvesters, hospitals and enterprise schemes they have funded provide a bedrock for future growth and prosperity or will they become rusting reminders of how development aid does not work?
President Ernest Koroma, who once said that he would like to run his country like a commercial business, is having none of all this negativity about NGO's.
He accepts that development aid here has its faults but insists that it is in everyone's interest to make schemes work, however difficult achieving that may be. "It is being used to help our poor people. It is used to stabilise the economy," he says.
"And, I believe it is quite useful that we will help the spread of growth all over the world. Because, if the growth in the world is distorted there will be a lot of pressures, immigration pressures and other pressures to your countries."
That may be true but unless the gains from donor money in countries like Sierra Leone become more obvious, pressure on overseas aid budgets, could start growing too.
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