We'd get over the "scandal" that a quarter of aid is technical assistance, decried because recipient countries don't get cash. Such skills are painfully absent among the last billion, whose educated tend to emigrate. In fact, we'd fund more and better technical assistance – especially in agriculture, property rights, banking, and governance.
The leadership and citizens of African countries, particularly those adjoining landlocked and desperately poor nations, would take bolder steps to diversify their economies, create new markets across borders, cut "protective" tariffs and red tape, clamp down on spurious "fees" that enrich bureaucrats, and implement reforms of their own to avert having terms dictated by wealthy donor nations.
We'd push harder on labor standards by giving the International Labor Organization some real authority to ensure that wealth from business and resource development does more than enrich local elites. A national minimum wage was made law in the US to preempt bottom-fishing in the poorest regions. Given the global nature of markets now, it's time to negotiate an international minimum wage, pegged to purchasing power parity for a basic basket of subsistence goods.
To stop the flow of aid money siphoned off in fees and bribes by corrupt officials and sent to personal first-world bank accounts, we'd have international banks make the freezing and repatriation of such deposits far easier. We do it with funds suspected of terrorist ties – but not with money sent to save lives? Of the minority of bankers profiting from corrupt deposits, economist Paul Collier pithily notes, "We have a word for people who live on the immoral earnings of others: pimps."
We'd remove tariffs on goods made in the poorest nations until they get a sustainable export base going. We'd also renegotiate pharmaceutical patent rules that sanction the poorest countries if they don't enforce them to Western standards. These rules make no sense where lost drug sales would be negligible and millions of lives would be saved.