NAIROBI, KENYA—The crowd milled around, half curious, half appalled, on a busy thoroughfare in Kenya, the main link between the capital Nairobi and the lakeside market town of Naivasha. The centre of their attention: a row of bodies—whether lifeless or simply stunned was not immediately clear—laid out on the grassy verge. They were the survivors or victims of a head-on crash caused, it was possible to say with some confidence, by bad road conditions, poor vehicle maintenance and incompetent policing.

This everyday tragedy illustrates a simple point. However passionately foreign donors may agonize about whether their contributions to African health ministries meet their constituents’ needs, or how much “leakage” robs the intended beneficiaries of their just desserts, no Western health aid program could ever compensate for the neglected infrastructural duties of the state. When a state fails in these duties, donors are left picking up the bodies, rather than providing a better future for the living.

Since African countries achieved independence in the 1960s, they have received over 400 billion dollars in aid from the West, much of which has—for obvious reasons—been funneled into the health sector. Kenya has received billions of dollars in aid and debt relief over the past few decades, including $213 million in aid from the U.S. alone in 2006, much of it to combat HIV.

But the main contribution that any African state makes to its citizens’ well being is not quantified in terms of insecticide spraying, anti-HIV drugs or antibiotics—it is in terms of the very basics of public services: decent roads, clean water, electricity, and effective communications. In Kenya, half the population lives on only a few dollars a day and the risk of infectious disease from unsanitary food and water remains very high.

No Western health aid program could ever compensate for the neglected infrastructural duties of the state. When a state fails in these duties, donors are left picking up the bodies, rather than providing a better future for the living.

Contrary to past experience, Western donors still subscribe to the notion that it is possible to “ringfence” aid. Organizations such as Britain’s Department for International Development (DFID), or the U.S. Agency for International Development (USAID), convince themselves that aid budgets can be isolated from corrupt or incompetent governments, ensuring donated money reaches “the poorest of the poor.” However, such quarantining is simply not possible. Money is fungible. Even if the money is not stolen outright by corrupt elites—a chronic condition in Kenya—the degradation and malaise of the states over which these elites preside ensure it rarely reaches its desired recipients.

After 24 years of corruption under Daniel Arap Moi, hope was high when Mwai Kibaki was elected in 2002. He even hired former Transparency International Kenya Director, John Githongo, to root out corruption in his own government. But then Githongo unearthed too much, too close to Kibaki, and had to flee the country to avoid arrest. From his London home he continues to publish damning evidence that corruption is as endemic in the political system as bad roads and malaria are across the country.

But Githongo is not the only bright light still shining in Kenya's public policy scene. James Shikwati, who runs the Inter-Regional Economic Network, is the main host of the first African meeting outside of South Africa of the Mont Pelerin Society (MPS), which finishes today. MPS was founded in 1944 by Nobel Laureate Friedrich Hayek, and has consistently promoted policies that encourage liberty alongside development around the world. Over 100 delegates from more than 20 African nations discussed the real causes of African poverty: notably, the lack of the rule of law and widespread corruption, and not a lack of aid. Even some African politicians were there and agreed with the major causes of African failure. Not that anyone currently in Mr. Kibaki's regime was in attendance, but while policy stars like Mr. Shikwati continue to shine light on its failings, there is hope that it will be prodded towards reform.

It seems changes are coming, but slowly. While the road where the accident I came across is very poor, locals who traveled the same road 5 years ago assure me that it was once far worse, which may count in Mr. Kibaki’s favor in elections slated to take place at the end of the year. Mind you, it still took the ambulance an eternity to arrive. Traveling away from the crash, our vehicle passed the ambulance after about half an hour—meaning crash victims waited nearly an hour for even the most rudimentary treatment.

While aid continues to relieve the state of responsibilities and mask its failings, organic development in Kenya will always be uncertain. The future for the country and continent is in old ideas of liberty, and new local practitioners of it like James Shikwati.