Poor People Behaving Badly?

NYT columnist Nick Kristof had an uber-provocative Sunday column:

…if the poorest families spent as much money educating their children as they do on wine, cigarettes and prostitutes, their children’s prospects would be transformed. Much suffering is caused not only by low incomes, but also by shortsighted private spending decisions by heads of households.

The Obamzas, a Congolese family from the village of Mont-Belo that Kristof met, say they can’t afford $2.50 per month in fees required to keep their kids in school, or a $6 malaria net to protect them from disease. But mom and dad do use cell phones, which cost them $10 per month, and the Mr. Obamza admits to frequenting the local bars, spending around $12 every month on liquor.

Kristof cites a famous study by Esther Duflo and Abhijit Banerjee called The Economic Lives of the Poor: “the world’s poor typically spend about 2 percent of their income educating their children, and often larger percentages on alcohol and tobacco….The indigent also spend significant sums on soft drinks, prostitution and extravagant festivals.”

Kristof is treading into some very emotional territory here, and has stirred up anger among a few bloggers for playing into harmful stereotypes. We definitely condemn any stereotype of all poor African men as deadbeat dads and drunks, but think it’s legitimate to consider that poor people could behave in counterproductive and irrational ways...just like rich people do.

Imagine another columnist writing about a rich white dad driving while talking on his cell-phone after having a few beers, risking the lives of his children in the car. For that matter, who among us makes perfect, rational decisions about our health all the time?

A growing body of work, including the Duflo and Banerjee study and the recent book Portfolios of the Poor, contributes to understanding the complex economic lives of the poor and chips away at misconceptions about poor people having “nothing,” living hand-to mouth, and immediately spending every penny they receive on food and other absolute basic necessities.

Is it really such a big surprise that the poor also want recreation? That the poor have a life? Including some of the same vices that the rich have?

The larger issue is explaining the seeming irrationality of, for example, Mr. Obamza’s decision to spend his evenings in a bar while his children sleep without a mosquito net. Could it be that outsiders make simplistic assumptions about the perceived value of bed nets to people like Mr. Obamza?

For example, a chapter by Michael Kremer and Alaka Holla in the book What Works in Development shows that demand for bed nets (and other life saving technologies like de-worming drugs or water disinfectants) collapses once you change from giving them away for free to charging even a tiny amount. Does this show that some parents don’t think saving their child’s life is worth spending even a very small amount of money? Maybe, but more likely it indicates that there is something wrong with our assumptions, as Kremer and Holla explore.

Perhaps it is that parents do not really believe in the efficacy of nets, drugs, or water purification tablets. Going even further than Kremer and Holla, we speculate that belief in the scientific theories underlying all these products is not so easy to achieve in a poor society. Rich people believe in scientific medicine not only based on their education, but also because they see it working for themselves and everyone around them. Scientific medicine is a harder sell in a society that has never had a well-functioning health system to demonstrate its benefits.

Researchers are testing these and many other possible explanations (here the randomized controlled trials are actually more useful, compared to blanket statements like “nets work”). We are just as worried about stereotyping the poor as anyone else, but we’re also glad the previous taboo is falling. The efficacy of aid interventions depends very much on understanding the behavior of the poor.

Secret NGO Budgets: Publish what you spend

The following post was written by Till Bruckner, PhD candidate at the University of Bristol and former Transparency International Georgia aid monitoring coordinator. Are you ashamed of your organization’s budgets? Do you think your supporters would be shocked if they could see exactly how you are spending their money? Do you feel the need to keep your finances hidden from your local partners and clients? If you answered all three questions with “yes,” you might be working for an international NGO.

After the August 2008 war between Georgia and Russia, Transparency International (TI) Georgia, a local organization working on transparency and accountability issues, tried to track and monitor 4.5 billion dollars in humanitarian and reconstruction aid that donors had pledged. It was in for a shock.

Out of twelve NGOs that it asked to publicize the budgets of their ongoing projects, only one (Oxfam GB) complied. In an unusual display of interagency coordination, ten NGOs convened a meeting and wrote a joint letter to TI Georgia, arguing that they were unable to share their budgets at short notice as “there are a number of legal and contractual implications involved with donors, head office and other stakeholders which will take time to resolve.”

Nine of the signatories to the letter were members of InterAction, whose standards state that “organizations shall substantiate, upon request, that their application of funds is in accordance with donor intent or request” and that “the member organization shall be committed to full, honest and accurate disclosure of relevant information concerning its goals, programs, finances and governance.” In theory, the NGOs had committed themselves to transparency.

In Georgia, international development organizations have been advocating for greater transparency for years, teaching citizens that they have the right to know how their money is spent, ordering community-based organizations to publicly display the budgets of their micro-projects and telling local governments that they have the duty to provide financial information to those they serve. Years ago, I asked an NGO manager what he considered the greatest success of the project that he was running. “We finally got the district government to post its budget in the mayor’s office, where everybody can see it,” he proudly told me. When I suggested that he post his own project’s budget in his office, he recoiled. “This is an experimental project, so the overheads are very high,” he replied. “So it would be very difficult to explain.”

While there appears to be little hope of gaining access to project budgets through NGOs themselves, institutional donors are subject to legislation in their home countries. I filed a Freedom of Information request with USAID in May 2009 to request copies of the budgets of all NGO projects in Georgia funded by American taxpayers’ money. Six months later USAID informed me that it needed the consent of the NGOs to release this data as it might contain “confidential commercial information,” thereby closing the opacity loop: first NGOs had blamed donors for not being able to release budgets, and now the biggest donor was passing the buck back to NGOs.

After a series of follow-up emails to USAID's Information and Records Division had gone unanswered, I lodged a formal complaint with USAID's Inspector General in March 2010. Two months later, the Inspector General's office finally replied, saying “this matter does not fall within the investigative purview of our office” and passing the buck to the Director of Administrative Services. Meanwhile, one year after my original request for information, the budgets of US-funded NGOs in Georgia remain as elusive as ever.

Secrecy and charity make for strange bedfellows. Those who spend the public’s money in the name of the poor have a duty to make themselves accountable to rich and poor alike by publicly explaining how this money is being spent. Congress should step in and require USAID to publish what US-funded NGOs spend by posting full narrative and financial project proposals online as soon as a funding decision is taken.

Till Bruckner worked for NGOs in Georgia and Afghanistan before managing TI Georgia’s aid monitoring programme in 2008-2009. He is currently writing a PhD thesis on accountability and corruption in NGO projects in Georgia. The views in this article are those of the author alone, and do not necessarily reflect the views of TI Georgia. The author can be contacted at tillbruckner@gmail.com.

Aid Watch offers free PR advice to prime satire target

As experienced satirists, maybe we can do our part helping Aid CEOs avoid ridicule. For example, if you are the CEO of the (RED) campaign fighting AIDS afflicting the desperately poor in Africa, you might not want to appear in today's FT Power Dressing column (not available online) with quotes like these:

Suit by Gucci There are certain things that I am really particular about with my wardrobe..I like my suits to fit incredibly well; for example, I always have a little cut made of the inside of my trousers at the ankle so they sit better on my shoes....

...My shirts are tailor-made by Turnbull & Asser. Ready-made shirts tend to be too baggy around the waist and then you lose the sharpness of the suit.

Tie by Hermes ...I don't like fussy ties.

Socks by Gap ...if you are going to make the effort to have you suit cut impeccably, why ruin it by having socks that don't match?

How the audience educates the lecturer: skepticism and freedom

On Wednesday night I gave a lecture at LSE called "We Don't Know How to Solve Global Poverty and That's a Good Thing." The abstract I wrote beforehand was:

This lecture argues that occasions when development economists were more certain about 'the solution to global poverty' have often led to harmful consequences for the world's poor in the long-run. Sceptical criticism is a creative force that redirects attention and effort away from centrally-directed expert solutions towards effective decentralised problem-solving.

Here are some responses: how economists don't understand the link between poverty and growth,  a criticism of my claims to ignorance, and a bit more sympathetic summary.

I feel kind of like I am on a long personal intellectual journey trying to figure out how to reconcile my compassion for the world's poor with my painfully honest realization that there is no reliable evidence on exactly what to do to end poverty. Each new public lecture is trying out a solution to the conundrum on a smart audience, and then they educate me some more to take the next step (which will be tried in the next lecture).

I am trying to convince people that rigorous skepticism is a creative force because most of the damage is done by overconfident people who thought they knew the answer when they didn't.  And such skepticism doesn't leave us empty-handed: it forces us back on what are our core values:  democracy, human rights, individual liberties, that we follow for moral rather than pragmatic reasons. Autocratic "pragmatic" claims to deliver development if you will just give up your rights don't survive skeptical scrutiny.

One thing I learned from the LSE lecture is not to even bother trying to make any "pragmatic" case for democracy, because that evidence is just as weak as everything else, and that we can only choose democracy based on our values (which is also how historically it was chosen; there are no cases of societies choosing democracy based on econometric results).

Lant Pritchett and the hot Indian shower

A great story from Lant Pritchett, writing in the comments section of David Roodman’s blog, about how the development industry sets goals and targets. The way we articulate our goals affects how we set about achieving them.

I was living in India and discussing arrangements for household water supply with some development colleagues of mine. After about half an hour of pretty fruitless discussion I said, “Let’s step back. Tell me your long-run vision of the household water sector in India.”

They said “Our vision is that India meets the target that every household lives within half a kilometer of an improved water source capable of providing 40 liters of safe per person per day.”

I said, “I see the problem. My vision of success is that every Indian can take a hot shower inside their own home.”  The difference is that one can imagine meeting the first goal “programmatically” or with a series of “interventions” while the latter clearly requires endogenously functional systems.

No one I know wants to have to go to a group meeting to take a hot shower. They want to turn the tap and it works.

Their whole discussion, on whether microfinance is an example of “aid building a thriving, disruptive industry that enriches the institutional fabric of nations” or “an unfortunate work-around for the failures of mainstream financial systems to serve the poor,” is worth reading.

Commercial Imperialism? Political Influence and Trade During the Cold War

We exploit the recent declassification of CIA documents and examine whether there is evidence of US power being used to influence countries' decisions regarding international trade. We measure US influence using a newly constructed annual panel of CIA interventions aimed at installing and supporting leaders during the Cold War. Our presumption is that the US had greater influence over foreign leaders that were installed and backed by the CIA. We show that following CIA interventions there was an increase in foreign-country imports from the US, but there was no similar increase in foreign-country exports to the US. Further, the increase in US exports was concentrated in industries in which the US had a comparative disadvantage in producing, not a comparative advantage. This is consistent with US influence being used to create a larger foreign market for American products. Our analysis is able to rule out decreased bilateral trade costs, changing political ideology, and an increased supply of US loans and grants as explanations for the increase in US exports to the intervened country. We provide evidence that the increase in US exports arose through direct purchases of US products by foreign governments.

This is the abstract for an NBER Working Paper just released, which I co-authored with Daniel Berger, Nathan Nunn, and Shanker Satyanath. Read the whole thing here.

The “Stuff We Don’t Want” flowchart

UPDATE: Scott has taken some of your suggestions to improve the chart--Version 2.0 is below. I doubt we need to point out that if you’re about to embark on an aid project to help Africa with no actual knowledge of aid or Africa, the ire of a certain blogging development economist may not be your greatest preoccupation. And we probably also don’t need to mention that developing a simple set of standards (perhaps in the form of a basic decision tree) won’t solve all the many well-documented problems with gifts-in-kind aid.

But who knows, it might help to weed out a few misguided and potentially harmful projects, so…thanks to Scott Gilmore at Peace Dividend Trust for drawing up this handy flowchart:

Scott instructs:

Print it, laminate it, keep it in your wallet, and rest easy knowing you won’t inadvertently attract the bloodthirsty wrath concerned interest of the aid critics.

Refinements or additions, anyone?

On a related but more serious note, Saundra Schimmelpfennig recently reminded us of an earlier blog post, How to determine if an aid project is a good idea, which is basically a lesson in empathy (“…ask yourself…is this is the type of aid you would want or would something else be more helpful? Would that aid project help solve the real problem or just address a side effect of the real problem? How would that same problem best be solved in your state/neighborhood?”) to help potential individual donors make good funding decisions.

Dani Rodrik's pessimism on democracy: let the debate begin!

Dani has been dropping tantalizing hints about his forthcoming book. One of his arguments, as judging by the preview in his column on the Greek crisis, is the political trilemma: Democracy, globalization, the nation state are not mutually compatible, you can only pick 2 out of 3.

I look forward to the book for the detailed logic and evidence. Of course, skepticism is allowed already, since Dani's already put it out there and since the burden of proof is on the proponent of a new hypothesis. So far I have 2 big reasons for skepticism:

(1) exaggerating the constraints of globalization.

Dani has a much more respectable version of this than Tom Friedman's ridiculous "golden strait jacket," but the reason for doubt are the same: we do observe a lot of diversity of policies in the rich globalized economies, and they became rich all the same.

(2) over-predicting the demise of either democracy or good economics

There's a long history of arguments about why democracy is incompatible with good economics that benefits everyone. Either the masses will vote to expropriate the capitalists, or the capitalists will use their wealth to buy votes to get power to exploit the masses. Neither happened in capitalist democracies (maybe the two threats cancel each other out).

So I am skeptical about the Rodrik Trilemma, but maybe the book will provide some convincing arguments. Can't wait!

Scratch and win for authentic malaria drugs

Here’s a problem most people in rich countries don’t often have to deal with: wondering whether the drugs you’ve just picked up from your local pharmacy will kill you, save your life, or give you just enough active ingredients to create a new drug-resistant strain of an otherwise curable disease. Counterfeiting does happen in rich countries, but more prevalently with “lifestyle drugs” like Viagra or allergy meds. Poor countries often have thriving counterfeit markets for drugs needed to combat more life-threatening diseases like malaria—for example in a recent study in Madagascar, Senegal and Uganda, between 26 and 44 percent of antimalarial drugs failed quality tests.

What if consumers could scratch off a panel on a drug package, send a text message containing that package’s unique 10-digit code, and get back a message that the drugs were authentic and safe to use, or fake? This is the idea behind mPedigree, a start-up led by Ghanaian social entrepreneur Bright Simons. According to a recent Bloomberg article mPedigree is planning a trial of their system using 125,000 packets of antimalarials in Ghana and Nigeria later this year. A rival service called Sproxil, started by another of mPedigree’s founders, Ashifi Gogo, is being deployed in Nigeria.

The idea’s brilliance lies in its reliance on two existing, affordable, and familiar technologies: the cell phone and the scratch card. Access to cell phones in Ghana and Africa as a whole has increased rapidly over the last decade, and scratch cards are a common way for people to top up their pre-paid cell phones.

The potential benefits are clear. From the perspective of the consumer, mPedigree is a quick, easy and cheap way to discover whether just-purchased drugs are real or fake. For drug makers, the new service will allow them to capture a greater share of the market as they drive out fakes and low-quality competitors.

On the other hand, this raises the question of who will be protected and who will be excluded if the services become widespread. If the idea spreads to drugs for which there are locally-made versions or legitimate generics available, will larger drug makers who use mPedigree be able to drive smaller firms who can’t afford it out of business? Or will mPedigree strive to include all the legitimate drug makers in the market?

mPedigree’s scratch and win panels are no permanent substitute for what’s missing in those markets where counterfeit antimalarials flourish—namely a well-functioning drug regulatory system, good consumer education about the danger of fakes, and a plentiful supply of effective antimalarials that are affordable and available to all who need them. But as a stopgap measure, they might be a winner.

Attention Chinese government, be sure to censor this

Great article in NYT Book Review by Emily Parker on the Chinese government successfully inhibiting academic freedom and freedom of speech in the West.

The Chinese-Canadian writer Denise Chong’s ...  {2009} book, “Egg on Mao,” ... tells the true story of Lu Decheng, who threw paint-filled eggs at Mao’s portrait in Tiananmen Square during the 1989 protests.  ... A Canadian nonprofit economic development group that had invited her to appear at a fund-raiser began playing down its association with her book once learning of the title, Chong said. ...

The United States Library of Congress declined an invitation to hold an event with Chong, suggested by the Canadian Embassy. In a recent telephone interview, a library employee involved in the discussions acknowledged that the political sensitivity of the book was one factor in the decision, along with the library’s relationship with the National Library of China.

{Princeton China scholar Perry} Link ...has been repeatedly denied a visa to China since the mid-’90s, apparently for helping the Chinese dissident Fang Lizhi seek refuge in the American Embassy during the 1989 protests.  Link’s predicament casts a long shadow over other China watchers. “Three or four times a month I get questions from students: How can I avoid getting on a blacklist like you?” Link said. He adds that he’s seen doctoral students avoid writing about democracy in China out of fear of the blacklist.

This reminds me of the heavy-handed pressure by the Chinese government on the World Bank during my days there (which has probably escalated in the 9 years since). As just one example, if I did an academic paper putting the name "Taiwan" in some obscure table of econometric results, I would be required to say instead "Taiwan Province of China." (I usually ignored this requirement, a small step towards that upward trajectory out of the World Bank.)

More recently, the Chinese government has reportedly exerted pressure limiting the practical use of the World Bank Institute's Governance Indicators, which measure democracy as one of their six indicators (with the Chinese of course scoring very poorly, they don't look so good on corruption either). Perhaps this accounts for the contortions on the web site for the Governance Indicators:

{They are} one of the most comprehensive cross-country sets of governance indicators currently available....

"the Worldwide Governance Indicators show that governance and corruption can be robustly measured and the lessons drawn can in fact be put to subsequent use by reformist governments, the development community, civil society and the media" said John Githongo,

...{they} are not used by the World Bank Group to allocate resources {aid}.

While the World Bank has at the same time been making the case for over a decade that:

Aid is less effective in a weak governance environment.

So Chinese government, what ARE we allowed to talk about? Well, the official World Bank blog does have good coverage of  a Chinese dung beetle named after a World Bank staffer.

Search for bone marrow donor for Devan

UPDATE 5/18 the family has announced a potential donor has been found for Devan! Thanks to all of you who spread the word & we should all keep campaigning for donor registering, particularly for non-Europeans. This is a very different post. 4 year old Devan's life is at stake. He needs to find a matching bone marrow donor and he has 11 weeks left. The family are particularly looking for people of mixed South Asian-European ancestry like Devan. The procedures for testing and donation are painless. If you go to Devan's web site, you will see the details.

I do not know Devan or his family. But a friend of mine does and he asked me to help spread the word. I really don't know if I am violating the unwritten rules of blogging with this post. If so, feel free to tell me. My attitude is forget the rules, why not use all social media possible if it could save a child's life. If you agree, please help spread the word and widen the search.

UPDATE 5/16 10:45am : some conversation on Twitter about this:

gentlemandad @bill_easterly so is it good aid to focus on one child's needs?

I think @gentlemandad raises an uncomfortable but legitimate question: do I have a double standard on trying to help one family with a tragic situation who is within my social circle (with one degree of separation -- friend of a friend) vs. my activities on this blog to try to help a lot of families with tragedies in faraway lands?

Other responses on Twitter to this stream:

knowgreen @bill_easterly Nothing about that struck me as an aid platform. Maybe add a line w/ link to have people register their bone marrow.

PDTglobal Instinctive human compassion and good aid is not a zero sum game.

The question is should I intellectualize and generalize to the usual areas of debate on this blog, or just respond  to the tragic plight of 4 year old Devan?

The tragic fall of the WASPs

Robert Frank in The Wall Street Journal on the decline of the WASP establishment (nobody left on the Supreme Court!)  The picture shows a meeting of the Daughters of the American Revolution in New York. Heart-rending episodes:

In old-money enclaves like Palm Beach, Fla., Nantucket, Mass., and Greenwich, Conn., WASPs are being priced out of their waterfront estates and displaced on their nonprofit boards by Jewish, Catholic and other non-Protestant entrepreneurs.

Elites are not forever! Interesting insight in a book published at the height of power of the WASPs in 1964:

In "The Protestant Establishment," Mr. Baltzell pointed to the prejudice and insularity of the elite as the eventual causes of its decline. "A crisis has developed in modern America largely because of the White-Anglo-Saxon Protestant establishment's unwillingness, or inability, to share and improve its upper-class traditions by continuously absorbing talented and distinguished members of minority groups into its privileged ranks."

Poor/ Not Poor

How many times have you looked at a picture of a forlorn or sick person in tattered clothing accompanying a news story or plea for aid funds, and wondered about the circumstances surrounding that particular shot? For me, these pictures often create a momentary feeling of intimacy—a privileged view into the most private details of someone’s life—that makes me wonder: What was this person doing a few moments before the photographer arrived? Or an hour later? Did the photographer exchange a few words with her subject, or just snap the shot on her way to somewhere else? A fledgling photography project from Duncan McNicholl, an aid worker with Engineers without Borders Canada working on water and sanitation in Malawi, probes the familiar conventions of poverty porn. In the project he’s calling “Perspectives on Poverty,” Duncan presents two photos of the same subject side by side, “to show how an image can be carefully constructed to present the same person in very different ways.”

From Duncan’s blog post:

Edward [pictured above] is quite successful, both as an area mechanic and through other business initiatives. He grows tobacco, works with a basket weaving business, collects rent from a shop he rents out in the market, and services over 60 water points in his area. Next year, he is thinking of investing in a truck to start a transportation business. He is a great example of how little a thatched roof says about someone’s livelihood.

Edward was pretty excited about the project, but he had a pretty hard time keeping a straight face for the photos of him trying to look "poor." He looked so ridiculous that I’ve included one of the photos in the set. The photos of Bauleni Banda [not pictured here] had the same kind of hilarity, with community members shouting out helpful hints on how to "look more poor." Neither had any trouble putting on their best and looking sharp.

Read his post for more context and check out other pictures here. Looking forward to more as the project progresses.

Hat tip to Owen (whom we’ve cited before for his posts on how PlayPumps are really being used in Malawi), blogging at Barefoot Economics.

Esther-mania!

Esther Duflo is having a good month, first the John Bates Clark medal for best economist under 40, and now a new profile in the New Yorker. It’s great to see development economists appearing in the New Yorker (link to abstract, full article alas requires subscription).

Esther is very deserving of this recognition. Anyone who gets hundreds of other academics and researchers approaching things in a new way (“randomized controlled trials” to measure the impact of development projects by comparing treatment and control groups) deserves tremendous credit.

A couple of things I liked about the New Yorker article:

Her childhood view of the poor, Duflo said, was shaped by “Protestant left-wing Sunday School.”

In Duflo’s view, both sides of the Sachs-Easterly argument reflect an unrealistic public desire “for an expert discourse, which is going to be able to tell you: This is going to be the end of poverty.” Duflo…argues that “there is not going to be le grand soir – one day, the big revolution, and the whole world is suddenly not corrupt. But maybe you create a small little virtuous group here and something else there. All these things are incremental.”

What I really did NOT like about the New Yorker article:

It gives short shrift to criticisms of the limits of Randomized Trials,  quoting Lant Pritchett and Angus Deaton so briefly that I doubt the general reader will even get the criticism. The article spends more time on a completely inappropriate attack on the tone and alleged “elitism” of these critics than explaining why MANY in economics today feel discomfort with the claims made for Randomized Trials.

A warning from Tajikistan

The following post was written by Alanna Shaikh. Alanna is a global health professional who blogs at UN Dispatch and Blood and Milk. A polio outbreak is underway in Tajikistan. 12 people have died of the diseases since March. 32 cases of polio have been confirmed, and 171 cases of acute flaccid paralysis (a signal of possible polio) have been identified. That’s a full-fledged outbreak in a country with an 82% vaccination rate. Until this January, there hadn’t been a polio case in Tajikistan for 13 years; Tajikistan was certified polio-free in 2002.

Tajikistan should simply not be seeing a polio outbreak – an 82% vaccination rate is enough to achieve herd immunity and protect even the unvaccinated. And we know this is not one of the rare vaccine-caused outbreaks because the WHO has done genetic analysis on the polio strain – it is wild polio.

Something has gone wrong in the health sector in Tajikistan. There are several ways that the health system could fail on vaccination. Vaccine records could be inaccurate, causing unvaccinated children to be missed by the system. Or the cold chain is not being maintained and the vaccines are losing effectiveness – the oral polio vaccine is especially vulnerable to warm temperatures. Whatever happened, it’s a sign of health system weakness and the Ministry of Health of Tajikistan will need support to improve it.

This outbreak calls into question the disease eradication approach to public health. Tajikistan has shown genuine commitment to polio eradication and that commitment has not been enough. Without a health sector strong enough to ensure effective vaccination coverage, a single-disease focus just doesn’t work. That idea is slowly being accepted. Eradication proponent Bill Gates called the eradication approach into question in his annual letter, mentioning slow progress to date in Nigeria.

If disease eradication is not the key to promoting global health, what is? Successful immunization against dangerous childhood diseases requires the same basic health sector resources as fighting HIV, protecting maternal health, and preventing chronic illnesses: a sufficient number of trained staff, useful data and the ability to act of it, health infrastructure, and effective financing methods. Support for those resources therefore strengthens a nation’s health as a whole.

Moving to a health systems approach for supporting global health will maximize the impact of global health spending. Every dollar spent will battle more than one disease. A broad systems approach also directly supports the goals of disease eradication by making sure that health staff are available, and trained, to provide vaccinations, and that the logistical system is in place to keep vaccines cold.

A systems approach will also support the structures needed to maintain disease elimination. Even after polio has been eliminated from a region, vaccination for the disease needs to continue as long as it still exists in human patients anywhere. And surveillance is necessary to watch and prepare for new outbreaks of the disease, like the one we are seeing in Tajikistan.

Tajikistan’s polio outbreak is a warning sign. You can’t eliminate a disease without also building a health system that ensures the disease stays eliminated.

TIME magazine covers 1Million Shirts

Jason Sadler, the guy behind 1MillionShirts, didn’t know what he was up against:

Little did Sadler know that he had stumbled into a debate raging in the aid world about the best and worst ways to deliver charity, or whether to give at all. He crashed up against a rather simple theory that returned to prominence after failures during the 2004 Asian tsunami and the Haiti earthquake: wanting to do something to help is no excuse for not knowing the consequences of what you're doing.

The TIME magazine article published today, by Nick Wadhams, a Nairobi-based journalist, offers some closure to the bloggers, aid workers and aid watchers who have been following this debate since it broke out two weeks ago: Sadler “no longer plans to send the shirts to Africa. He says he will find another way to use the T-shirts he collects, possibly for disaster relief, giving them to homeless shelters or using them to create other goods.”

In addition to Bill Easterly, Kenyan Economist James Shikwati, and the aid worker and blogger known as Tales from the Hood, Wadhams quotes Kenyan journalist Rasna Warah:

"Africa is the greatest dumping ground on the planet. Everything is dumped here." Adds Warah: "The sad part is that African governments don't say no — in fact, they say 'Please send us more.' They're abdicating responsibility for their own citizens."

Read the whole thing here.

--

See our previous blogs on the subject here: A suggestion for the 1MillionShirts guy Nobody wants your old T-shirts

And see an exhaustive collection of posts about 1MillionShirts here.

Rwanda’s coffee success story

A walking tour through some of the trendiest coffee shops in the NYU vicinity reveals a common element: creatively packaged, expensive Rwandan coffee for sale.

Given our long-standing interest in 1) good coffee and 2) the potential of entrepreneurship for development, this phenomenon clearly merited investigation. The work of Karol Boudreaux, who has been following the Rwandan coffee sector for several years, helps to sketch the outlines of a partially donor-funded development success story now unfolding.

The history of coffee in Rwanda is intertwined with the country’s political fortunes, and stretches back to the 1930s when the Belgian colonial government required Rwandan farmers to plant coffee trees, while setting price restrictions and high export taxes, and controlling which firms could purchase coffee. These policies helped create a “low-quality/low-price trap” that would bedevil the post-colonial governments that continued similarly heavy-handed policies. They also ensured a national distaste for the stuff—reportedly even today many Rwandans prefer tea.

In the late 1980s global coffee prices plummeted, and the economic devastation following Rwanda’s 1994 genocide wiped out what remained of the struggling industry. In 2000, there was no functioning infrastructure to wash and process coffee beans, meaning that what little coffee was produced was of poor quality.

Fast forward ten years to today: Rwanda has a National Coffee Strategy. Rwandan specialty coffee is winning international competitions, commands some of the world’s highest prices, and is sought out by Starbucks, Green Mountain Coffee, Intelligentsia, and Counter Culture Coffee. There is preliminary evidence that the coffee industry is creating jobs, boosting small farmer expenditure and consumption, and possibly even fostering social reconciliation by reducing “ethnic distance” among the Hutus and Tutsis who work together growing and washing coffee.

How did this happen? First, the Rwandan government lowered trade barriers, and lifted restrictions on coffee farmers. Second, Rwanda developed a strategy of targeting production of high-quality coffee, a specialty product whose prices remain stable even when industrial-quality coffee prices fall. Third, international donors provided funding, technical assistance and training, creating programs like the USAID-funded Sustaining Partnerships to Enhance Rural Enterprise and Agribusiness Development (SPREAD). SPREAD's predecessor started the first Rwandan coffee cooperative as an experiment in 2001, and the project continues its work improving each link in newly-identified high-value coffee supply chains.

Some problems and constraints still plague the Rwandan coffee sector. For example, transport costs remain high, and poor management at some coffee cooperatives points to a persistent need for good training and financial management skills.

Still, Rwanda’s revenues from coffee are still growing in the face of global recession, and these revenues bring real benefits to Rwanda’s rural poor.

NYT on HIV/AIDS crisis: “You cannot mop the floor when the tap is still running on it”

UPDATE 4:10pm 5/11: Bill responds to Gregg Gonsalves' comment on this post, at the END of the post. The New York Times ran not one but two articles (edit: make that four) on the global fight against HIV/AIDS last Sunday. As these pieces tragically recount, the international community’s hard won successes against HIV/AIDS are in danger. There is not enough funding to meet the demand for treatment among sick patients in Uganda, and expiring grants, frozen funds, and drug shortages have already or are expected soon to spread to Nigeria, Swaziland, Botswana, Tanzania and Kenya.

The last decade has been what some doctors call a “golden window” for treatment. Drugs that once cost $12,000 a year fell to less than $100, and the world was willing to pay.

In Uganda, where fewer than 10,000 were on drugs a decade ago, nearly 200,000 now are, largely as a result of American generosity. But the golden window is closing.

The reasons given for current and projected shortages include the global recession; a “growing sense” among donors that more lives can be saved more cost-effectively fighting other diseases like malaria or pneumonia; and the disappointing failure of the scientific community to find a cure or vaccine.

The most devastating breakdown of all comes down to failure to prevent enough new infections and a simple, brutal equation:

For every 100 people put on treatment, 250 are newly infected, according to the United Nations’ AIDS-fighting agency, Unaids. … “You cannot mop the floor when the tap is still running on it,” said Dr. David Kihumuro Apuuli, director-general of the Uganda AIDS Commission.

UPDATE 4:10pm 4/11 from Bill: I am responding to Gregg Gonsalves’ comment below

Dear Gregg,

First, on the complementarity between treatment and prevention, let’s clear up some things. There is some complementarity, conceivably a lot, but it’s definitely not perfect. Treatment is not necessary and sufficient to do prevention. Prevention will remain a separate goal that needs at least SOME direct attention even if there is a lot of complementarity.

Second, I think to move forward we all have to move out of our defensive positions.

You see my plea for attention to prevention as an attack on treatment programs. There is some justification for this, as I and others have argued, and still would argue, that treatment was used as an excuse by aid and political actors in both the West and Africa to ignore prevention. This is because prevention is both politically and technically more difficult than treatment. But suppose you disagree with this argument – that’s fine. Suppose we all even gave up that argument and said let treatment programs alone. Suppose that none of us blame treatment at all for the inattention to prevention.

Could you then discuss prevention without spending most of your effort defending treatment? Prevention is now not working, as you acknowledge yourself. You are right that there are no obvious new solutions now, but some solution must be found sooner or later – bottom up, top down, or sideways – because you acknowledge that prevention has to work to end the AIDS tragedy. Could everyone involved in AIDS therefore agree there needs to be a new focused conversation and effort on prevention?

Regards, Bill

Misunderstandings of Affirmative Action: Supreme Court Edition

I'm poorly qualified to pronounce on Affirmative Action as a general topic. But I do see misunderstandings that overlap with one of my favorite topics: errors in perceiving probabilities. Before you say BORING, let me try to convince you that this is at the heart of the AA debate.

The #1 question about Elena Kagan is "did she get nominated because she's a woman?" There is no way to answer this for one unique case, but we can ask for women in general, do they benefit a lot from AA?

As usual there are two probabilities that are often confused with each other. The first is that IF there is a big promotion because of AA for women, THEN the beneficiary will be a woman. This probability is 100% by definition.

The second probability is that IF you are a woman, THEN you benefit a lot from AA. I leave it to the experts to figure out this exactly, but you don't have to be an expert to know this is a lot lower than 100%. If we are talking about AA primarily affecting promotions to a high position, then this is intrinsically rare for both men and women. It follows that this 2nd probability would be very low, because few women are affected by promotions to highly selective positions.

Yet because we often confuse reverse conditional probabilities (i.e. the two probabilities above), as discussed in many previous posts, we think a lot more women are benefiting from AA (which is perceived to be unfair by many) than really are. Conversely, very few men are really being affected by reverse discrimination (again because highly selective promotions are rare to begin with).

So bottom line of this post: I get really annoyed to see the accomplishments of my female professional friends and colleagues stigmatized because they are seen, most of the time incorrectly, as Affirmative Action babies.

PS One interesting aside relevant for today's previous post. If Kagan is confirmed, the Supreme Court will consist of 6 Catholics and 3 Jews, none of whom would have been considered to fit the core definition of "white" before the mid-19th century in America.

Before I was white

Nell Irvin Painter is an African-American historian at Princeton. I just finished her fascinating History of White People. The big story is what a slippery category "White" is, and how many today considered "White" used not to be. My German and Scots-Irish ancestors, some of whom probably arrived as indentured servants (i.e. temporary slaves),  were called "guano" (birdsh*t) by Ralph Waldo Emerson in 1851. Emerson of course placed Anglo-Saxon English at the top of the racial hierarchy.

But my ancestors later made it into the top in solidarity against new waves of "black" Irish Catholic immigrants in the mid-19th century, considered to belong to the inferior Celtic race.

Irish Catholics in turn were moved up into whiteness when the "swarthy" southern Europeans and eastern European Jews arrived in the late 19th century and early 20th century. These latter would become "white" in the 20th century, but not before racist hysteria slammed the American immigration door shut just before Jews and others desperately needed to escape from fascism in Europe.

Painter ranges far and wide, detailing efforts to define the poor as a separate race, and poverty a hereditable condition. Not to mention nonsense about skull measurements, and mythical histories of mythical peoples like Saxons, Nordics, and Aryans, all in a desperate attempt to have a bright line between White and non-White.

Now we know that no such line exists, but not before "race experts" spent a couple generations in power in the academic establishment. Good cautionary tale for being careful and modest when we attempt to talk about ethnicity and development today.