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Its principally a corruption issue.

Western governments and corporations reinforce crony, incompetent governments in developing countries so that their resources can be exploited.

These crony governments then steal (literally) from the population who need it. Until the poor governance issues are resolved, a lot of foreign aid is wasted.

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Part of the problem there is ironically that African cultures often look after each other. If somebody becomes a doctor, then it's expected that s/he feeds pretty big part of the extended family. This disincentives getting good salary, you want to get just slightly above average.

And that's why you get biggest impact by sharing the money as evenly as possible.

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